Free Content A randomised controlled clinical trial of the efficacy of family-based direct observation of anti-tuberculosis treatment in an urban, developed-country setting

 Download
(PDF 394.8kb)
 
Download Article:

Abstract:

SETTING: A randomised, controlled clinical trial of the effectiveness of a family-based programme of directly observed treatment (DOT) for tuberculosis.

METHODS: TB patients seen in Victoria, Australia, were randomly allocated to DOT observed by a family member (FDOT), or to standard supervised but non-observed therapy (ST). The outcome measure was compliance, measured by blinded testing of isoniazid levels in urine. An intention-to-treat analysis was used.

RESULTS: Of 173 patients, 87 were allocated to FDOT and 86 to ST. Only 58% in the FDOT group were able to receive FDOT, the major reason being living alone and not having a family member to observe treatment. The rate of non-compliance was 24% (41/173), with no significant difference between FDOT (22/87) and ST (19/86). No clinical or socio-demographic variable predicted compliance.

CONCLUSIONS: We were unable to demonstrate a benefit of FDOT in an urban, industrialised country setting. FDOT may be more appropriate in developing countries, where extended family support is often available and the burden of TB is much higher. Poor compliance and the difficulty in predicting non-compliance shown in this study highlights the need for DOT for all TB patients.

Keywords: DOT; adherence; therapy; tuberculosis

Document Type: Regular Paper

Affiliations: 1: ChildrenÕs Hospital at Westmead, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, NSW, Australia; and Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia 2: Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia; and Department of Human Services, Victoria TB Program, Melbourne, Australia 3: Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia 4: Department of Human Services, Victoria TB Program, Melbourne, Australia; and Epidemiology & Biostatistics Unit, Royal ChildrenÕs Hospital, Melbourne, Australia 5: Department of Infectious Diseases, Royal ChildrenÕs Hospital, Melbourne, Australia 6: Special Chemistry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia

Publication date: September 1, 2003

More about this publication?
  • 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

  • Editorial Board
  • Information for Authors
  • Subscribe to this Title
  • International Journal of Tuberculosis and Lung Disease
  • Public Health Action
  • ingentaconnect is not responsible for the content or availability of external websites
Related content

Tools

Favourites

Share Content

Access Key

Free Content
Free content
New Content
New content
Open Access Content
Open access content
Subscribed Content
Subscribed content
Free Trial Content
Free trial content
Cookie Policy
X
Cookie Policy
ingentaconnect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more