The occurrence of significant drug resistance in many countries, coupled with known problems in delivering directly observed therapy (DOT), calls for a re-examination of tuberculosis (TB) treatment delivery strategies. Electronic medication monitors, devices that determine when medication
is removed from containers, and videophone-based strategies are being introduced to determine if they can effectively differentiate 1) patients who are adequately adherent to self-administered treatment (SAT), 2) less reliable patients who could be successfully treated with SAT if given more
intensive counseling and 3) patients who require DOT. The adherence record could be used in deciding on compensatory longer treatment when poor adherence occurs. The time saved not giving DOT to all patients could be used to retrieve defaulters. Together these components constitute a monitor-based
strategy. The program could be extended to supervise the adherence of private patients to medication provided by trained and subsidized pharmacies with the physicians or, when necessary, health departments managing poorly adherent patients. When patients move, the device could transfer essential
data to the new care giver. To obtain optimal results, the requirements for the best possible devices and procedures for dealing with poor adherence need to be carefully evaluated.
No Supplementary Data
directly observed therapy;
Document Type: Regular Paper
Division of Respiratory and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
Publication date: 2011-07-01
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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.
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