Abstract
Directly Observed Treatment Short course (DOTS) is one of the most cost-effective approaches for TB treatment. However, TB incidence rates remain high in the mountain areas of Taiwan. A lay health advisor (LHA) strategy is integrated into DOTS as an Enhanced-DOTS (E-DOTS) to provide trustworthy, culturally-specific services in mountain areas that consider the characteristics of local ethnic groups. We recruited two Taiwanese indigenes as LHAs (one for each county) to screen close contacts in five townships of Hualien and Nantou counties from January 1, 2011 to December 31, 2013. Incidence and active finding rates of TB during the E-DOTS periods (2011-2013 for Hualien and 2012-2013 for Nantou) were compared with data when traditional DOTS was implemented (2006-2010 for Hualien and 2006-2011 for Nantou) to evaluate the effectiveness of E-DOTS using the before-and-after study design. Incidence rate in Hualien decreased from 393.3 in 2011 to 235.7 in 2013 per 100,000 population and from 338 in 2012 to 235.5 in 2013 in Nantou mountain area. Furthermore, the active case finding rate increased from 15.42% in 2012 to 27.38% in 2013 as compared to an average of 6.5% for CDC, Taiwan, for the specified years. TB treatment success rates were significantly improved from an average of less than 80% to an average of higher than 90% after E-DOTS was implemented. Our findings highlighted that the use of LHAs in E-DOTS is an effective and applicable strategy for controlling tuberculosis in the mountain areas of Taiwan.
Highlights
Observed Treatment Short course (DOTS) is one of the most cost-effective approaches for TB treatment
Examinations done were similar between Directly Observed Treatment Short course (DOTS) and E-DOTS in terms of gender, age and sputum results
The number of TB cases detected by active case screening were increasing annually in both Nantou and Hualien area
Summary
Observed Treatment Short course (DOTS) is one of the most cost-effective approaches for TB treatment. TB incidence rates remain high in the mountain areas of Taiwan. Results: Incidence rate in Hualien decreased from 393.3 in 2011 to 235.7 in 2013 per 100,000 population and from 338 in 2012 to 235.5 in 2013 in Nantou mountain area. Conclusions: Our findings highlighted that the use of LHAs in E-DOTS is an effective and applicable strategy for controlling tuberculosis in the mountain areas of Taiwan. The incidence rate and death rate were reduced by 24.1% and 1.8%, respectively, compared to 2005, TB is still one of the most important public health issues in Taiwan. The incidence rate of TB has decreased from 72.5/100,000 in 2005 to 48.4/100,000 in 2014, ever since the implementation of DOTS at 2006 in Taiwan [2]. TB incidence rates remain even higher in the mountain areas [7].
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