[Results and epidemiological impact of directly observed treatment of tuberculosis].

OBJECTIVES

To analyze the results and epidemiological impact on tuberculosis (TB) of directly observed therapy (DOT) for uncooperative patients.

METHOD: Retrospective study of the case histories of patients admitted to the DOT unit in Catalonia (Spain) since its March 1993 inauguration until August 1998.

RESULTS

Of a total of 470 patients, 102 were cared for during the unit's first phase, in which funding resources were insufficient. Of the 368 admitted during the second phase beginning January 1996; 176 (47.5%) were cured, 27 (7.3%) died, 72 (19.5%) were still at the unit and 93 (25.2%) left the unit before completing treatment. Of the last group, 25 were cured, 31 died 19 continued DOT and 18 (4.9% of all enrolled in the second phase) were lost to follow-up. Thus, the final outcome distribution for the patients was 201 (54.6%) cured, 58 (15.7% died, 91 (24.7%) still in DOT and 18 (4.9%) lost to follow-up. The compliance rate during the second phase was 91.8%. These results may have contributed significantly to the nearly 30% reduction in the incidence of TB in Catalonia between 1992 and 1997, a period which saw large decreases in the number of cases among 20-to-44-year-olds (33%) and consequently also among under-15-year-olds (55%). Likewise the number of cases of TB in high risk groups decreased, 55% on the average with a minimum decrease of 40.1% among AIDS patients and a maximum decrease of 85.2% among indigents.

CONCLUSION

DOT has proven highly effective both for patients and for the community, although many other factors must also be considered when accounting for the current epidemiological trend.