Increasing directly observed therapy related to improved tuberculosis treatment outcomes in Taiwan.
METHODS
Directly observed therapy (DOT) is a core element of tuberculosis (TB) care and control efforts. In Taiwan, DOT was implemented in 2006, when the Stop TB Strategy was adopted as a national policy.


OBJECTIVE
To quantify DOT among patients on anti-tuberculosis treatment and measure the association between proportion of DOT and TB treatment outcomes at a national level in Taiwan.


METHODS
We analyzed data prospectively collected on all new pulmonary TB cases reported to the national web-based registry between 1 January 2007 and 30 June 2008. We compared treatment outcomes and proportion of DOT in multivariable analyses.


RESULTS
Among 11,528 patients initiating anti-tuberculosis treatment, the proportion of days during which an official DOT observer witnessed treatment was >60% for 5150 (45%) patients and ≤60% for 4601 (40%) patients, whereas for 1777 (15%) patients no days of DOT were recorded. Being older, male, having positive bacteriology results and a non-World Health Organization recommended treatment regimen at baseline were independently related to unsuccessful treatment outcomes and mortality. A dose-response effect was found between proportion of DOT and these outcomes.


CONCLUSIONS
These findings highlight the importance of ensuring universal DOT in improving treatment outcomes among new pulmonary TB patients.
Division of Tuberculosis Elimination, International Research and Programs Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. dpu2@cdc.gov
E
E
Bloss
P-C
PC
Chan
N-W
NW
Cheng
K-F
KF
Wang
S-L
SL
Yang
P
P
Cegielski
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D023801:Directly Observed Therapy / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006291:Health Policy; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D013624:Taiwan; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*; D055815:Young Adult
D000995:Antitubercular Agents