Abstract
Directly observed therapy (DOT) is a core element of tuberculosis (TB) care and control efforts. In Taiwan, DOT was implemented in 2006, when the Stop TB Strategy was adopted as a national policy. To quantify DOT among patients on anti-tuberculosis treatment and measure the association between proportion of DOT and TB treatment outcomes at a national level in Taiwan. We analyzed data prospectively collected on all new pulmonary TB cases reported to the national web-based registry between 1 January 2007 and 30 June 2008. We compared treatment outcomes and proportion of DOT in multivariable analyses. Among 11,528 patients initiating anti-tuberculosis treatment, the proportion of days during which an official DOT observer witnessed treatment was >60% for 5150 (45%) patients and ≤60% for 4601 (40%) patients, whereas for 1777 (15%) patients no days of DOT were recorded. Being older, male, having positive bacteriology results and a non-World Health Organization recommended treatment regimen at baseline were independently related to unsuccessful treatment outcomes and mortality. A dose-response effect was found between proportion of DOT and these outcomes. These findings highlight the importance of ensuring universal DOT in improving treatment outcomes among new pulmonary TB patients.
Published Version
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