title: Directly observed therapy of tuberculosis in Brazil: associated determinants and impact on treatment outcome.
abstract: METHODS
  All Brazilian states.
  
  
  OBJECTIVE
  To assess the determinants of tuberculosis (TB) in patients undergoing directly observed therapy (DOT) and the impact of DOT on treatment outcomes.
  
  
  METHODS
  This is a cross-sectional study among TB patients aged ⩾18 years conducted in 2011. The primary outcome was the status of DOT received, while the secondary was the outcome of anti-tuberculosis treatment.
  
  
  RESULTS
  In 2011, 35 775 (38.3%) subjects received DOT. The odds of receiving DOT were higher in patients with the following characteristics: brown/mestizo patients (OR 1.18, 95%CI 1.14-1.22) and those of other ethnic groups (OR 2.01, 95%CI 1.79-2.27) compared to Whites, alcohol users (OR 1.37, 95%CI 1.28-1.47) and those with mental disorders (OR 1.88, 95%CI 1.54-2.29). The odds of receiving DOT were lower in human immunodeficiency virus positive patients (OR 0.64, 95%CI 0.60-0.68). Patients who did not receive DOT were more likely to default from anti-tuberculosis treatment (OR 0.62, 95%CI 0.57-0.66), die due to TB (OR 0.68, 95%CI 0.61-0.77) and to have unknown treatment outcomes (OR 0.71, 95%CI 0.66-0.76). The adjusted preventable fraction of DOT in the reduction of unfavorable outcomes was 25%.
  
  
  CONCLUSIONS
  Sociodemographic and clinical characteristics are determinants of anti-tuberculosis treatment outcomes in patients undergoing DOT; DOT use led to a 25% reduction in unfavorable outcomes.
authors.affiliation: Lab-Epi Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
authors.forename: B
authors.initials: B
authors.lastname: Reis-Santos
authors.affiliation: Lab-Epi Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
authors.forename: I
authors.initials: I
authors.lastname: Pellacani-Posses
authors.affiliation: Lab-Epi Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
authors.forename: L R
authors.initials: LR
authors.lastname: Macedo
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Golub
authors.affiliation: Division of Infectious Disease and Vaccinology, School of Public Health, University of California, Berkeley, California, USA.
authors.forename: L W
authors.initials: LW
authors.lastname: Riley
authors.affiliation: Lab-Epi Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
authors.forename: E L
authors.initials: EL
authors.lastname: Maciel
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001938:Brazil; D003430:Cross-Sectional Studies; D023801:Directly Observed Therapy / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000995:Antitubercular Agents