Evaluation of directly observed therapy for tuberculosis in KwaZulu-Natal, South Africa
Transactions of the Royal Society of Tropical Medicine and Hygiene
Unit for Clinical and Biomedical TB Research, South African Medical Research Council (SAMRC), 491 Ridge Road, Overport, 4067, South Africa; Malaria Research Programme, South African Medical Research Council (SAMRC), P.O. Box 70380, Overport, 4067, South Africa
Tuberculosis (TB) is one of the leading causes of morbidity and mortality in KwaZulu-Natal (KZN), South Africa. Directly observed therapy (DOT) is a key element of the WHO's Directly Observed Treatment, Short Course (DOTS) strategy to control TB. Since the inception of DOTS in South Africa in 1996, its impact has never been assessed. We evaluated the DOT programme in the priority facilities of the four TB crises districts (EThekwini, UMgungundlovu, UMzinyathi and UThungulu) in the province of KwaZulu-Natal. A semi-structured questionnaire was used to interview TB nurses and community DOT supporters. The primary outcome used was cure rate. On average, priority facilities in districts that have high DOT coverage had better cure rates compared with those that have low DOT coverage (β = 0.818, 95% CI 0.023-1.614; P = 0.045). The fewer the number of patients allocated to a DOT supporter the higher the cure rates (β = -1.984; 95% CI -3.88 to 0.086; P = 0.041). There was no difference in cure rates between facilities with tangible reporting and recording methods and those with none. These findings suggest that cure rates can be improved if DOT is implemented appropriately. © 2009 Royal Society of Tropical Medicine and Hygiene.
article; controlled study; directly observed therapy; health care facility; health program; nurse; South Africa; tuberculosis; tuberculosis control; AIDS-Related Opportunistic Infections; Antitubercular Agents; Directly Observed Therapy; Female; HIV-1; Humans; Male; Program Evaluation; South Africa; Tuberculosis; Mycobacterium tuberculosis