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Free Content Directly observed therapy (DOT) is not the entire answer: an operational cohort analysis

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Abstract:

SETTING: New Jersey Medical School National Tuberculosis Center—Lattimore Clinic, a TB Clinic for an inner city population of Newark, New Jersey, USA.

OBJECTIVE: Directly observed therapy (DOT) is the recommended standard of TB care. Recent reports suggest that DOT may not be any better than self-administered therapy (SAT). To quantify the impact of different levels of SAT, DOT, and active case management on outcomes of TB treatment at our location, we reviewed the outcomes of six TB patient-cohorts from Newark between 1 January 1994 and 31 December 1996.

STUDY DESIGN: A retrospective cohort study of the outcomes of 343 tuberculosis patients treated during the years 1994–1996. The three treatment strategies were 1) self-administered with occasional selective directly observed therapy, 2) universal directly observed therapy alone (universal DOT), and 3) universal DOT with nurse case management (NCM).

RESULTS: The first two cohorts who began treatment during the transition may have received more than one treatment strategy. However, universal DOT did not significantly improve the TB treatment completion rates of Cohort 2 over SAT therapy with selective DOT given to Cohort 1. Universal DOT with NCM, Cohorts 3, 4, 5, and 6, significantly increased the TB treatment completion rates by three to six times. A cohort-specific stepwise reduction in duration of treatment from a median of 11.6–7.5 months and an increase in completion rates from 57–81% resulted. The most desirable and optimal (shortest) duration of treatment completion coincided with the application of universal DOT combined with NCM.

Keywords: adherence; case management; directly observed therapy

Document Type: Regular Paper

Affiliations: 1: Department of Medicine, New Jersey Medical School National Tuberculosis Center, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA 2: Department of Preventive Medicine and Community Health, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA 3: Tuberculosis Control Program, The New Jersey Department of Health and Senior Services, Newark, New Jersey, USA 4: Department of Medicine, New Jersey Medical School National Tuberculosis Center, University of Medicine and Dentistry of New Jersey; and the Department of Preventive Medicine and Community Health, New Jersey Medical School, University of Medicine a

Publication date: 2002-08-01

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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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