Directly observed therapy (DOT) is frequently seen as the answer to rising levels of tuberculosis. However, well conducted trials comparing DOT with self treatment have showed that the effects of DOT on cure or treatment completion are similar to those of self-administered treatment. The objective of this study was to determine the effect of DOT on the outcome of antituberculosis treatment.
Retrospective analysis covering the period 01/2000-09/2004; the information was retrieved from the files of the Tuberculosis Control Program, ISESALUD, Ensenada, Mexico.
524 patients were included in the analysis. 462 patients (88.16%) had never been treated before, 57 (10.8%) were relapses, and 5 (0.95%) were failures from a previous regimen. DOT was administered to 73.7% of the patients; in the rest (26.3%), treatment was self administered. Males defaulted treatment more frequently (25.5%) than females (16%; p=0.010). HIV/AIDS patients defaulted treatment more frequently (38.5%) than those not co-infected (20.3%), however due to the low number of coinfected patients (13), this difference was not statistically significant (p=0.11). Patients addicted to illegal drugs and/or alcohol also defaulted treatment more frequently (31.6% vs. 19.3%, p=0.014). In logistic regression analysis only male gender (odds of abandoning treatment: 1.70, CI95% 1.03, 2.81; p=0.03) and the absence of addictions (OR 0.55, CI95% 0.32, 0.97; p=0.04) were predictive of treatment completion. DOT was not predictive (1.33, CI95% 0.77, 2.30; p=0.30).
DOT did not improve in this group of patients treatment completion, treatment failure and cure rates when compared with self-administered treatment.
Universal DOT is an expensive strategy; TB programs from developing countries might benefit from selecting for DOT, patients with high risk for deafult.
Rafael Laniado-Laborin, None.