title: Evaluation of adherence to national treatment guidelines among tuberculosis patients in three provinces of South Africa.
abstract: METHODS
  Standardised tuberculosis (TB) treatment through directly observed therapy (DOT) is available in South Africa, but the level of adherence to standardised TB treatment and its impact on treatment outcomes is unknown.
  
  
  OBJECTIVE
  To describe adherence to standardised TB treatment and provision of DOT, and analyse its impact on treatment outcome.
  
  
  METHODS
  We utilised data collected for an evaluation of the South African national TB surveillance system. A treatment regimen was considered appropriate if based on national treatment guidelines. Multivariate log-binomial regression was used to evaluate the association between treatment regimens, including DOT provision, and treatment outcome.
  
  
  RESULTS
  Of 1 339 TB cases in the parent evaluation, 598 (44.7%) were excluded from analysis owing to missing outcome or treatment information. The majority (697, 94.1%) of the remaining 741 patients received an appropriate TB regimen. Almost all patients (717, 96.8%) received DOT, 443 (59.8%) throughout the treatment course and 274 (37.0%) during the intensive (256, 34.6%) or continuation (18, 2.4%) phase. Independent predictors of poor outcome were partial DOT (adjusted risk ratio (aRR) 3.1, 95% confidence interval (CI) 2.2 - 4.3) and previous treatment default (aRR 2.3, 95% CI 1.1 - 4.8).
  
  
  CONCLUSIONS
  Patients who received incomplete DOT or had a history of defaulting from TB treatment had an increased risk of poor outcomes.
authors.affiliation: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. jhe3@cdc.gov.
authors.forename: Julia V
authors.initials: JV
authors.lastname: Ershova
authors.forename: Laura Jean
authors.initials: LJ
authors.lastname: Podewils
authors.forename: Liza E
authors.initials: LE
authors.lastname: Bronner
authors.forename: Heather G
authors.initials: HG
authors.lastname: Stockwell
authors.forename: Sicelo S
authors.initials: SS
authors.lastname: Dlamini
authors.forename: Lerole D
authors.initials: LD
authors.lastname: Mametja
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D023801:Directly Observed Therapy / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D013019:South Africa; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*; D055815:Young Adult