DOTS in primary care units in the city of Rio de Janeiro, Southeastern Brazil

Abstract

OBJECTIVE:To describe the implantation and the effects of directly-observed treatment short course (DOTS) in primary health care units. METHODS:Interviews were held with the staff of nine municipal health care units (MHU) that provided DOTS in Rio de Janeiro City, Southeastern Brazil, in 2004-2005. A dataset with records of all tuberculosis treatments beginning in 2004 in all municipal health care units was collected. Bivariate analyses and a multinomial model were applied to identify associations between treatment outcomes and demographic and treatment process variables, including being in DOTS or self-administered therapy (SAT). RESULTS:From 4,598 tuberculosis cases treated in public health units administrated by the municipality, 1,118 (24.3%) were with DOTS and 3,480 (75.7%) with SAT. The odds of DOTS were higher among patients with age under 50 years, tuberculosis relapse and prior history of default or treatment failure. The odds of death were 52.0% higher among patients on DOTS as compared to SAT. DOTS modality including community health workers (CHWs) showed the highest treatment success rate. A reduction of 21.0% was observed in the odds of default (vs. cure) among patients on DOTS as compared to patients on SAT, and a reduction of 64.0% among patients on DOTS with CHWs as compared to those without CHWs. CONCLUSIONS:Patients with a "low compliance profi le" were more likely to be included in DOTS. This strategy improves the quality of care provided to tuberculosis patients, although the proposed goals were not achieved.

Nursing performance in the policy transfer of directly observed treatment of tuberculosis

“…Recent national and international scientific studies recommend the continuous monitoring of patients with TB, with supervision of drug therapy by a health professional, aiming at improving the quality of health care, the enhancement of treatment adherence and for preventing the emergence of tuberculostatic resistant bacteria (2)(3)(4)(5) . However, there is research showing that the difficulties in the operation of directly observed treatment (DOT) compromise the achievement of positive impacts related to the rates of cure and abandonment of treatment, and recommend attention to regional specificities, since the operationalization of DOT is heterogeneous depending on the different geographical spaces where it is developed (6)(7)(8) .…”

Cost-Effectiveness Analysis of Directly Observed Therapy for Tuberculosis and Its Expansion in Rio De Janeiro

“…Two studies that conducted a cost-effectiveness analysis of DOT performed in healthcare units in Rio de Janeiro rated DOT as a cost-effective strategy [9,13]. In Monhan et al (2007) study, the ICER for DOT was USD 300 per case averted, USD 3,270 per death averted and USD 86 per disability-adjusted life year (DALY) saved [9].…”

“…In Monhan et al (2007) study, the ICER for DOT was USD 300 per case averted, USD 3,270 per death averted and USD 86 per disability-adjusted life year (DALY) saved [9]. To Steffen et al (2010), the ICER was USD 6,616 per completed DOT treatment [13].…”

“…The data used in the model were extracted from databases and cost-effectiveness studies [9,10]. Health states represent the forms of progression of infection.…”

“…Average percentages for the period of 2007-2014 were calculated for the following outcomes: treatment dropout, death due to tuberculosis and death due to other causes (table 1). These percentages were considered as probabilities, and the same value was used for the treatment failure outcome, as it is not associated with the DOT and SAT strategies [9].…”