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(Chest. 1998;114:1239-1243.)
© 1998 American College of Chest Physicians

A Controlled Comparison of Directly Observed Therapy vs Self-administered Therapy for Active Tuberculosis in the Urban United States

Bruce L. Davidson MD, MPH, FCCP1

1 From the City of Philadelphia Department of Public Health, Tuberculosis Control Program, and the Division of Pulmonary and Critical Care Medicine, Allegheny University of the Health Sciences, Philadelphia, PA.

Bruce L. Davidson, MD, MPH, 301 S. 19th St, Philadelphia, PA 19103; e-mail: brucedavidson{at}pobox.com

Study objectives: To compare treatment completion rates at 8 and 12 months after treatment initiation for patients with active TB treated with either directly observed therapy (DOT) or self-administered therapy (SAT).

Design: Retrospective comparison study of DOT and SAT concurrent patient cohorts.

Setting: Urban Tuberculosis Control Program within a Department of Public Health.

Patients: Three hundred nineteen patients confirmed to have active TB between July 1, 1994, and June 30, 1995, who began outpatient drug therapy.

Interventions: Patients and/or their physicians chose to receive their anti-TB drug therapy by DOT (n=113) or SAT (n=206) and were assessed for treatment completion at prospectively determined times, 8 and 12 months.

Measurements and results: Proportions of patients who completed treatment at 8 and 12 months without crossing over to the other group were compared. At 8 months, 52% of DOT and 35% of SAT patients had completed treatment (relative superiority of DOT, 49%; p=0.003). At 12 months, completion rates were 70% for DOT patients and 53% for SAT patients (relative superiority of DOT, 30%; p=0.006).

Conclusions: In our setting, patients receiving DOT were much more likely to complete treatment earlier than those receiving SAT. Even with DOT, only 52% of patients had completed treatment by 8 months.

Key Words: directly observed therapy • supervised therapy • treatment adherence • treatment completion • tuberculosis

Submitted on April 2, 1998
Accepted on June 16, 1998




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