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Free Content Implementation of universal directly observed therapy at a New York City hospital and evaluation of an out-patient directly observed therapy program

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SETTING: Directly observed therapy (DOT) program for tuberculosis (TB) at a New York City hospital.

OBJECTIVE: To describe a specific TB DOT program model utilizing active prospective identification of in-patients, and identify factors associated with patient acceptance of voluntary DOT and with their retention in therapy.

METHODS: Recruitment for DOT by daily surveillance of in-patients. DOT was offered as the patient's choice together with concrete services and incentives. On-site DOT was offered in an out-patient clinic. Outreach efforts were initiated when a patient missed one or more DOT visit.

RESULTS: During the study period, 95% of 176 in-patients with TB were evaluated for DOT. Of the 137 who were eligible for DOT, 85% (95% confidence interval [CI], 77.5% to 90%) elected to receive DOT. Illicit drug use was independently associated with a higher likelihood of acceptance of DOT (odds ratio [OR], 4.88; 95% CI, 1.5–15.7). Among the 101 patients who received on-site DOT, illicit drug use (OR, 0.21; 95% CI, 0.08–0.6) and previous TB therapy (OR, 0.27; 95% CI, 0.27–0.7) were both independently associated with lower retention in therapy. However, with intensive case management, only 1% of this cohort was lost to follow-up and the overall treatment completion index was 98%.

CONCLUSION: In-patient surveillance is a highly effective DOT recruitment strategy. A DOT model which elicits patient participation in discharge plans and offers incentives can yield a high rate of voluntary acceptance. Out-patient case management is a highly effective means of ensuring treatment completion, especially in those at risk for poor retention.

Keywords: adherence; directly observed therapy; tuberculosis

Document Type: Regular Paper

Affiliations: Department of Medicine, Beth Israel Medical Center, New York, New York, USA

Publication date: October 1, 1997

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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