title: Modified directly observed treatment for tuberculosis versus self-administered therapy: an observational study in rural Greece.
abstract: BACKGROUND
  Directly Observed Treatment (DOT) is the key element of DOTS (directly observed treatment, short course), part of the internationally recommended control strategy for tuberculosis (TB). The evaluation of DOT has not been widely evaluated in rural areas in developed settings. The aim of this pilot study was to evaluate a modified DOT program (MDOT) by a general practitioner (GP) in a rural area of southwest Greece, where there is substantial underreporting of TB cases.
  
  
  METHODS
  Thirteen new TB cases with 30 close contacts were compared with 41 past-treated TB subjects (controls) with 111 close contacts in this observational, case-control study. Home visits by a GP were conducted and comparison of various data (laboratory findings, treatment outcomes, questionnaire-based parameters, on-site recorded conditions) was performed in both newly detected pulmonary TB cases and previously treated TB cases managed without DOT intervention.
  
  
  RESULTS
  MDOT by GP implementation revealed that 11 cases (84.6%) were successfully treated, one (7.7%) case died, and one (7.7%) was lost to follow up. None of the close contacts of new TB cases was infected with active TB, while 6.3% of previously-treated TB subjects were infected with active TB and had to receive a complete anti-TB regimen. Chemoprophylaxis was administered to 13.3% of close contacts of new cases; whereas 12.6% of close contacts of previously-treated patients received chemoprophylaxis.
  
  
  CONCLUSIONS
  This pilot study revealed that a GP is able to implement a program based on DOT resulting in high treatment adherence and prevention of TB compared with the conventional self-administration of treatment.
authors.affiliation: Division of Pneumology, Department of Internal Medicine, General Hospital of Pirgos, Pirgos, Greece. charok64@hotmail.com
authors.forename: N
authors.initials: N
authors.lastname: Charokopos
authors.forename: G
authors.initials: G
authors.lastname: Tsiros
authors.forename: A
authors.initials: A
authors.lastname: Foka
authors.forename: P
authors.initials: P
authors.lastname: Voila
authors.forename: K
authors.initials: K
authors.lastname: Chrysanthopoulos
authors.forename: I
authors.initials: I
authors.lastname: Spiliopoulou
authors.forename: E
authors.initials: E
authors.lastname: Jelastopulu
mesh_terms: D023801:Directly Observed Therapy; D005260:Female; D006115:Greece; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D019035:Rural Health Services; D012646:Self Administration / Q000379:methods*; D014376:Tuberculosis / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology / Q000628:therapy*