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 profile" 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.
Highlights
According to the World Health Organization (WHO), Brazil ranks 18th among 22 countries in tuberculosis (TB) cases accounting for 80.0% of all cases worldwide
From 4,598 tuberculosis cases treated in public health units administrated by the municipality, 1,118 (24.3%) were with directly-observed treatment short course (DOTS) and 3,480 (75.7%) with self-administered therapy (SAT)
The odds of DOTS were higher among patients with age under 50 years, tuberculosis relapse and prior history of default or treatment failure
Summary
According to the World Health Organization (WHO), Brazil ranks 18th among 22 countries in tuberculosis (TB) cases accounting for 80.0% of all cases worldwide. Given the relevance of TB in Brazil, in 1998, the Brazilian Ministry of Health launched the National Plan to Fight Tuberculosis, which proposed the implementation of the Directly Observed Treatment Short-Course (DOTS) Strategy, tuberculosis control programs (TCP) in 100.0% of the country’s municipalities, adequate treatment of 100.0% of the diagnosed cases, cure of at least 85.0% of these cases, and a default rate of less than 5.0%. Rio de Janeiro has the highest TB mortality rate in Brazil, i.e., 6.0 per 100,000 inhabitants in 2004, nearly twice the national rate.a It accounted for 42.0% of multidrugresistant tuberculosis (MDR-TB) cases in the Southeast in 2000–2003, the Brazilian region with the highest proportion of cases in the country (66.4%).[3] Cure rate was 68.2% and default rate was 16.3% in 2004. Of all cases reported in the state of Rio de Janeiro, 54.0% lived in the city of Rio de Janeiro
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