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Intervention Review

Directly observed therapy for treating tuberculosis

  1. J Volmink,
  2. P Garner

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 20 JAN 2003

DOI: 10.1002/14651858.CD003343


How to Cite

Volmink J, Garner P. Directly observed therapy for treating tuberculosis. The Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003343. DOI: 10.1002/14651858.CD003343.

Author Information

*Prof Jimmy Volmink, Chair of Primary Health Care, Primary Health Care Directorate, University of Cape Town, E47 Old Main Building, Groote Schuur Hospital, Observatory 7925, Cape Town, SOUTH AFRICA. jvolmink@cormack.uct.ac.za.

Publication History

  1. Published Online: 20 JAN 2003

SEARCH

This is not the most recent version of the article. View current version (17 OCT 2007)

 

Abstract

  1. Top of page
  2. Abstract
  3. Synopsis

Background

Up to half the people with tuberculosis do not complete their treatment. Thus strategies that improve adherence to treatment regimens are important.

Objectives

To compare policies of directly observed therapy with self treatment at home in people requiring treatment for clinically active tuberculosis, or requiring medication for prevention of active disease, on cure and/or treatment completion.

Search strategy

We searched The Cochrane Controlled Trials Register (Issue 3, 2002), the Cochrane Infectious Diseases Group trials register (August 2002), MEDLINE (1966 to August 2002), EMBASE (1980 to August 2002), LILACS (accessed August 2002), and reference lists of articles. We also contacted experts in the field.

Selection criteria

Randomized and quasi-randomized trials of appointed agents (health worker, community volunteer, or family member) directly observing people swallowing their antituberculous drugs compared with self treatment for tuberculosis.

Data collection and analysis

Two reviewers independently assessed the methodological quality of the trials and extracted data.

Main results

Six studies included (n=1910). Patients allocated to directly observed therapy (DOT) compared had similar outcomes in relation to cure (Relative Risk (RR) 1.06; 95% confidence interval (CI) 0.98 to 1.14); and cure plus treatment completion (RR 1.06; 95% CI 1.00 to 1.13). A stratified analysis by the appointed agent (health professional, lay health worker, or family/community member) did not detect any important differences. One study conducted in an optimal setting in which participants were given a choice of supervisor did show modest benefit (cure RR 1.13; 95% CI 1.04 to 1.24; cure plus treatment completion RR 1.11; 95% CI 1.03 to 1.18).

Two trials assessed the effects of direct observation on completion of antituberculous preventive therapy in intravenous drug users in the USA. One study found no difference between DOT by an outreach nurse and routine self treatment (RR 1.02; 95% CI 0.89 to 1.18). The other study compared completion rates between participants who chose their DOT location and those receiving DOT at a community clinic and failed to demonstrate a significant difference (RR 0.88; 95% CI 0.63 to 1.23).

Authors' conclusions

Well conducted trials comparing a policy of directly observed therapy with self treatment at home have been carried out in low, middle, and high income countries. Studies include people on treatment or people at high risk of developing tuberculosis. The effects of direct observation on cure or treatment completion were similar to those of self-administered treatment.

 

Synopsis

  1. Top of page
  2. Abstract
  3. Synopsis

Plain language summary

In people with tuberculosis direct observation of treatment yielded similar cure and treatment completion rates as self-administration of treatment

People with tuberculosis need to take drugs for at least six months. Many do not complete their treatment course, and for this reason services for patients with tuberculosis often use different approaches to encourage people to complete their treatments. This review found no evidence that direct observation compared to self-administered treatment improved treatment adherence and outcomes.