Effectiveness of Directly Observed Therapy (DOT) for Tuberculosis

Hill, A. Ross; Manikal, Vivek M.; Riska, Paul

doi:10.1097/00005792-200205000-00002

Cited by 13 publications

(10 citation statements)

References 70 publications

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“…It was assumed that all studies under RNTCP were using intermittent therapy. Some studies (Cox,[8] Hill[2]) have included all types of therapies, both intermittent and daily. Thus, possible difference between intermittent and daily regimens may be very important, however, they are very poorly documented.…”

Section: Resultsmentioning

confidence: 99%

“…In the seven studies, three were reviews (Cox,[8] Hill,[2] Volmink[15]), one was a prospective study (Thomas[14]), and the rest three (Chandrasekaran 2006, Mehra,[9] Mukherjee[10]) were record-based studies under program conditions of RNTCP. These seven included studies will be discussed in the following section under two headings–relapse and other findings.…”

Section: Resultsmentioning

confidence: 99%

“…But this is considered unethical by some authors given the positive experience from it in practice settings. [2] Thus, an attempt is being made in this paper to find out more about these aspects of the tuberculosis (TB) control program in India by reviewing the existing evidence from published studies by the method of a systematic review.…”

Section: Introductionmentioning

confidence: 99%

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DOTS for TB relapse in India: A systematic review

Azhar¹

2012

Lung India

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In India, under the Revised National Tuberculosis Control Program (RNTCP), the percentage of smear-positive re-treatment cases is high. The causes of re-treatment include relapse of the disease after successful completion of treatment, treatment failure, and default in treatment. RNTCP does not follow up the patients for any period of time after successful completion of treatment to determine whether they relapse. Given the high cost of treatment for each patient under RNTCP and the potential for spread of disease from these patients, it is crucial for the success of the program and control of the disease in the country to find out more about the reasons behind this. T0 o conduct a systematic review of literature and determine evidence regarding recurrence of TB after its successful treatment with standard short course chemotherapy under DOTS guidelines. T0 en databases were searched including Medline, Cochrane database, Embase and others and reference lists of articles. 255 papers resulted from these searches. Seven studies were finally included in the review after applying the inclusion, exclusion and quality assessment criteria. R0 elapse rate is high (almost 10%) in India which is higher than international studies. Majority of relapse cases present soon after completion of treatment (first six months). Risk factors for relapse included drug irregularity, initial drug resistance, smoking and alcoholism Sex and weight were not risk factors in India. The outcome of relapse cases put on treatment is positive but less effective than new cases. There are sound arguments and sketchy evidence that DOTS Category 2 treatment may not be adequate for retreatment patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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DOTS for TB relapse in India: A systematic review

Azhar¹

2012

Lung India

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“…The additional cost of DOT for patients and their families is substantial, and may be contributing, in Rio de Janeiro, to the treatment completion rates below the targeted 85% recommended by WHO. Despite a reported increase in effectiveness in some settings [14], [16], [17] in poor-resource countries, DOT may be unaffordable, at least for the poorest.…”

Section: Discussionmentioning

confidence: 99%

Patients' Costs and Cost-Effectiveness of Tuberculosis Treatment in DOTS and Non-DOTS Facilities in Rio de Janeiro, Brazil

et al. 2010

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BackgroundCosts of tuberculosis diagnosis and treatment may represent a significant burden for the poor and for the health system in resource-poor countries.ObjectivesThe aim of this study was to analyze patients' costs of tuberculosis care and to estimate the incremental cost-effectiveness ratio (ICER) of the directly observed treatment (DOT) strategy per completed treatment in Rio de Janeiro, Brazil.MethodsWe interviewed 218 adult patients with bacteriologically confirmed pulmonary tuberculosis. Information on direct (out-of-pocket expenses) and indirect (hours lost) costs, loss in income and costs with extra help were gathered through a questionnaire. Healthcare system additional costs due to supervision of pill-intake were calculated considering staff salaries. Effectiveness was measured by treatment completion rate. The ICER of DOT compared to self-administered therapy (SAT) was calculated.Principal FindingsDOT increased costs during the treatment phase, while SAT increased costs in the pre-diagnostic phase, for both the patient and the health system. Treatment completion rates were 71% in SAT facilities and 79% in DOT facilities. Costs per completed treatment were US$ 194 for patients and U$ 189 for the health system in SAT facilities, compared to US$ 336 and US$ 726 in DOT facilities. The ICER was US$ 6,616 per completed DOT treatment compared to SAT.ConclusionsCosts incurred by TB patients are high in Rio de Janeiro, especially for those under DOT. The DOT strategy doubles patients' costs and increases by fourfold the health system costs per completed treatment. The additional costs for DOT may be one of the contributing factors to the completion rates below the targeted 85% recommended by WHO.

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“…Poor adherence to therapy remains a major obstacle to successful treatment of TB. The implementation of directly observed therapy systems (DOTS) for TB has improved compliance with regards to medication intake, treatment success and TB control [15]. However, the cure of TB remains a challenge, especially in those individuals infected with HIV and/or MDR and XDR M. tuberculosis strains.…”

mentioning

confidence: 99%

Immunological options for the treatment of tuberculosis: evaluation of novel therapeutic approaches

Achkar¹,

Casadevall²,

Glatman‐Freedman³

2007

Expert Review of Anti-infective Therapy

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The emergence of multidrug-resistant tuberculosis strains and the coinfection with HIV, together with advances in immunology, have led to renewed interest regarding ways to exploit the immune responses against Mycobacterium tuberculosis therapeutically. Here we review the fundamentals of tuberculosis therapy in view of the epidemiological and clinical challenges, and explore the experience with immune-based therapies for the treatment of active tuberculosis. These immune-based therapies are discussed here with the aim of assessing their potential use as adjuncts to chemotherapy.

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Effectiveness of Directly Observed Therapy (DOT) for Tuberculosis

Cited by 13 publications

References 70 publications

DOTS for TB relapse in India: A systematic review

DOTS for TB relapse in India: A systematic review

Patients' Costs and Cost-Effectiveness of Tuberculosis Treatment in DOTS and Non-DOTS Facilities in Rio de Janeiro, Brazil

Immunological options for the treatment of tuberculosis: evaluation of novel therapeutic approaches

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