title: Analysis of factors of treatment completion in dots health facilities in metro Manila, Philippines: a case-control study.
abstract: STUDY BACKGROUND AND OBJECTIVES: The Philippines is one of the 22 countries with high TB burden. DOTS was adopted not only by purely public providers (PP) but also by public-private mix (PPM) facilities. This study aims to identify the patient and facility factors that promote completion of TB treatment in DOTS facilities in an urban setting. The study also explores the difference between the PP and PPM DOTS facilities in terms of case management and treatment outcomes. [Methods] A case control study was done by interviewing 394 patients sampled from TB cohort report between 2003 and 2005 of 14 DOTS facilities in Metro Manila. Statistical analyses used include chi-square test and logistic regression analysis.
  
  
  RESULTS
  Being female and aged 30-44 (OR = 7.04; 95% CI 1.12-44.35), unemployed (OR = 2.73; 95% CI 1.18-6.33), being above per capita poverty threshold (OR = 2.03; 95% CI 1.03-3.99), having experienced at least one of the signs and symptoms of TB (OR = 4.64; 95% CI 1.29-16.67), taking the medication at health facility (OR = 3.87; 95% CI 1.48-10.16) and patient's understanding of DOT (OR = 2.67; 95% CI 1.37-5.23) predict TB treatment completion. Public-private mix type of DOTS facility was also significantly associated with completing treatment (chi 2 (1) = 54.76, p = 0.000).
  
  
  CONCLUSIONS
  Patient factors like middle-aged female compared to female aged more than 60, being above per capita poverty threshold, unemployment and having experienced at least one signs and symptoms of TB and facility factors like providing treatment at the facility and explaining the DOT to patient increase the likelihood of completing treatment. Thus, encouraging patients to take their medication at the facility and helping the patients understand the importance of DOT can increase TB treatment completion. The seemingly better DOTS implementation and treatment outcomes by the PPM must be evaluated further through cost effectiveness and efficiency studies.
authors.affiliation: Department of Health Policy Science, Graduate School of Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519 Japan. lei-hcm@tmd.ac.jp
authors.forename: Leizel P
authors.initials: LP
authors.lastname: Lagrada
authors.forename: Naruo
authors.initials: N
authors.lastname: Uehara
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kawahara
mesh_terms: D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D023801:Directly Observed Therapy / Q000706:statistics & numerical data*; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D010679:Philippines; D011203:Poverty; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*; D014478:Unemployment