The influence of program acceptability on the effectiveness of public health policy: a study of directly observed therapy for tuberculosis.

OBJECTIVES

This study examined how patient acceptability influences the effectiveness of directly observed therapy for tuberculosis.

METHODS

Decision and sensitivity analyses were used in assessing influences.

RESULTS

If mandatory directly observed therapy discourages 6% of initial tuberculosis patients (range: 4% to 10%) from seeking care, then such therapy will be less effective than self-administered therapy. Directly observed therapy is more effective than repeated self-administered therapy for patients failing to complete initial treatment unless 32% (range: 27% to 38%) of patients avoid seeking care.

CONCLUSIONS

Patient acceptability must be taken into consideration before selecting public health strategies.