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. 1998 Jul;88(7):1052–1058. doi: 10.2105/ajph.88.7.1052

Directly observed therapy and treatment completion for tuberculosis in the United States: is universal supervised therapy necessary?

R Bayer 1, C Stayton 1, M Desvarieux 1, C Healton 1, S Landesman 1, W Y Tsai 1
PMCID: PMC1508250  PMID: 9663153

Abstract

OBJECTIVES: This study examined the relationship between directly observed therapy and treatment completion rates in the years before and after infusion of federal funding for tuberculosis (TB) control in 1993. METHODS: An ecological study of estimated directly observed therapy rates and 12-month treatment completion rates from 1990 through 1994 was undertaken for TB control programs in all 25 cities and counties across the nation with 100 or more incident TB cases in any year from 1990 to 1993. Three cohorts were formed: high treatment completion, intermediate completion, and low completion. RESULTS: In 1990, the median 12-month treatment completion rate was 80% for the entire study population, with a median estimated directly observed therapy rate of 16.8%. By 1994, those rates had increased to 87% and 49.4%, respectively, and increases were shown in all 3 cohorts. CONCLUSIONS: Directly observed therapy has had a marked impact on treatment completion rates in jurisdictions with historically low rates. But TB treatment completion rates of more than 90% can be attained with directly observed therapy rates far lower than those proposed by advocates of universal supervised therapy.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Annas G. J. Control of tuberculosis--the law and the public's health. N Engl J Med. 1993 Feb 25;328(8):585–588. doi: 10.1056/NEJM199302253280825. [DOI] [PubMed] [Google Scholar]
  2. Bayer R., Dubler N. N., Landesman S. The dual epidemics of tuberculosis and AIDS: ethical and policy issues in screening and treatment. Am J Public Health. 1993 May;83(5):649–654. doi: 10.2105/ajph.83.5.649. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bayer R., Wilkinson D. Directly observed therapy for tuberculosis: history of an idea. Lancet. 1995 Jun 17;345(8964):1545–1548. doi: 10.1016/s0140-6736(95)91090-5. [DOI] [PubMed] [Google Scholar]
  4. Bloch A. B., Onorato I. M., Ihle W. W., Hadler J. L., Hayden C. H., Snider D. E., Jr The need for epidemic intelligence. Public Health Rep. 1996 Jan-Feb;111(1):26–33. [PMC free article] [PubMed] [Google Scholar]
  5. Chaulk C. P., Moore-Rice K., Rizzo R., Chaisson R. E. Eleven years of community-based directly observed therapy for tuberculosis. JAMA. 1995 Sep 27;274(12):945–951. [PubMed] [Google Scholar]
  6. FOX W. Self-administration of medicaments. A review of published work and a study of the problems. Bull Int Union Tuberc. 1962 Jul;32:307–331. [PubMed] [Google Scholar]
  7. FOX W. The chemotherapy and epidemiology of tuberculosis. Some findings of general applicability from the Tuberculosis Chemotherapy Centre, Madras. Lancet. 1962 Sep 8;2(7254):473–477. doi: 10.1016/s0140-6736(62)90338-0. [DOI] [PubMed] [Google Scholar]
  8. FOX W. The problem of self-administration of drugs; with particular reference to pulmonary tuberculosis. Tubercle. 1958 Oct;39(5):269–274. doi: 10.1016/s0041-3879(58)80088-4. [DOI] [PubMed] [Google Scholar]
  9. Frieden T. R., Fujiwara P. I., Washko R. M., Hamburg M. A. Tuberculosis in New York City--turning the tide. N Engl J Med. 1995 Jul 27;333(4):229–233. doi: 10.1056/NEJM199507273330406. [DOI] [PubMed] [Google Scholar]
  10. Hansell D. A. The TB and HIV epidemics: history learned and unlearned. J Law Med Ethics. 1993 Fall-Winter;21(3-4):376–381. doi: 10.1111/j.1748-720x.1993.tb01264.x. [DOI] [PubMed] [Google Scholar]
  11. Iseman M. D., Cohn D. L., Sbarbaro J. A. Directly observed treatment of tuberculosis. We can't afford not to try it. N Engl J Med. 1993 Feb 25;328(8):576–578. doi: 10.1056/NEJM199302253280811. [DOI] [PubMed] [Google Scholar]
  12. Jacobs S. L. Legal advocacy in a time of plague. J Law Med Ethics. 1993 Fall-Winter;21(3-4):382–389. doi: 10.1111/j.1748-720x.1993.tb01265.x. [DOI] [PubMed] [Google Scholar]
  13. Nardell E. A. Beyond four drugs. Public health policy and the treatment of the individual patient with tuberculosis. Am Rev Respir Dis. 1993 Jul;148(1):2–5. doi: 10.1164/ajrccm/148.1.2. [DOI] [PubMed] [Google Scholar]
  14. Pablos-Méndez A., Sterling T. R., Frieden T. R. The relationship between delayed or incomplete treatment and all-cause mortality in patients with tuberculosis. JAMA. 1996 Oct 16;276(15):1223–1228. doi: 10.1001/jama.1996.03540150025026. [DOI] [PubMed] [Google Scholar]
  15. Voelker R. 'Shoe leather therapy' is gaining on TB. JAMA. 1996 Mar 13;275(10):743–744. [PubMed] [Google Scholar]
  16. Weis S. E., Slocum P. C., Blais F. X., King B., Nunn M., Matney G. B., Gomez E., Foresman B. H. The effect of directly observed therapy on the rates of drug resistance and relapse in tuberculosis. N Engl J Med. 1994 Apr 28;330(17):1179–1184. doi: 10.1056/NEJM199404283301702. [DOI] [PubMed] [Google Scholar]

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