Direct observation and completion of treatment of tuberculosis in rural areas of China.
OBJECTIVE
To analyse the current status of directly observed therapy (DOT) and completion of treatment of tuberculosis (TB) in two rural areas of China.


METHODS
Two rural counties with low DOT rates were deliberately selected as study sites. Face-to-face interviews were conducted by trained investigators with a structured questionnaire to investigate the characteristics of patients and the TB service that they had received. The associations between treatment completion and potential factors were estimated by computing odds ratios (ORs), as well as their 95% confidence intervals (CIs), from an unconditional logistic regression model.


RESULTS
Among 601 patients, 2.2% were treated with direct observation by health workers, 6.2% were supervised by family members, and 91.7% were treated with self-administered therapy. The treatment completion rate was found to be significantly associated with sputum smear test and adverse reaction to anti-tuberculosis drugs, but not with direct observation by health workers (OR 1.81, 95% CI 0.23-14.38) or by family members (OR 1.14, 95% CI 0.38-3.41). Frequent home visiting by health workers (!1 visit/month) could help to increase the completion rate (OR 3.15, 95% CI 1.30-7.63).


CONCLUSIONS
No significant difference was found in the rate of completion of TB treatment between direct observation and self-supervision groups in two rural areas with lower DOT coverage. How to build a feasible DOT strategy that is accepted by both patients and healthcare providers needs to be considered by policy-makers. Other elements apart from DOT are necessary to ensure a successful TB programme.
Jianming Wang
Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China.
Hongbinh Shen
D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage; D002681:China / Q000453:epidemiology; D003150:Community Health Workers; D023801:Directly Observed Therapy; D005260:Female; D006792:House Calls; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011634:Public Health; D019035:Rural Health Services; D012646:Self Administration; D011795:Surveys and Questionnaires; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology
D000995:Antitubercular Agents