ReviewDirectly observed therapy and treatment adherence
Section snippets
Search for reports
We searched MEDLINE from 1996 to 1999, on “directly observed therapy” (textword) and “tuberculosis” (textword or MesH). In addition we searched EMBASE up to November, 1999, and the Cochrane Controlled Trials Register published in the Cochrane Library (issue 4, 1999). We also searched reference lists of original articles and reviews (JV). Data extraction was done by two researchers working independently and differences were resolved by discussion.
We included any study that had assessed the
Description of studies
Of the 111 studies identified, 32 describing 30 programmes or programme clusters met our selection criteria (table 1).4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 Most were from studies done in the USA (12) or South Africa (seven), and the rest were from the former Union of Soviet Socialist Republics (USSR, two), Cambodia (two), Nepal (one), Somalia (one), Mexico (one), Thailand (one), Philippines (one), China (one),
Analysis of inputs
Incentives of free food, clothes, or transportation tokens were provided in 11 programmes. In one US programme, patients received the equivalent of $US100 per month,21 and in another cigarettes were offered.28 Contracts, celebration of accomplishments with parties and certificates, health education, and help in obtaining housing, financial assistance, psychological support, and treatment for substance abuse were also common.
A unique feature of the US programmes, mentioned in five reports, was
Effectiveness of DOT programmes
All 32 studies mentioned the specific strategy of direct observation by a health worker or delegate of patients taking their drugs (table 2). 13 studies recorded a strengthened reporting system. 11 studies mentioned an improved drug supply, nine studies mentioned improvement in laboratory studies, and eight commented on political commitment.
The main purpose of this review was to summarise inputs as described in research reports of DOT programmes. We did not intend to summarise the quality of
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