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Directly observed therapy (DOT) appears to be the most effective treatment for tuberculosis, especially when it includes social services to help the patient comply with treatment. DOT means that a health care worker or social worker observes the patient take the medication. Researchers evaluated 27 studies of various treatment regimens for tuberculosis, 12 of which used DOT. The DOT studies reported treatment completion rates from 86% to 96%, whereas studies that did not use DOT reported treatment completion rates of 42% to 82%. DOT programs often give patients reminders, food and transportation to ensure compliance., Objective. -- To evaluate evidence on the relative effectiveness of directly observed therapy in achieving treatment completion for Pulmonary tuberculosis. Participants. -- A panel of 11 practitioners representing the public health, behavioral, and clinical management of tuberculosis was convened by the Council on Linkages Between Academia and Public Health Practice in 1995 to develop public health guidelines for tuberculosis treatment completion. Evidence. -- English-language articles identified through MEDLINE (1966 to August 1, 1996) with original data on directly observed therapy, supervised therapy, compliance, treatment completion, case management, and treatment adherence for tuberculosis. Consensus Process. -- Each eligible article underwent structured review by at least 2 panel members for study design, sample size, evaluation methods, and treatment completion as the primary outcome. The full panel was convened twice, with intercurrent small group meetings, conference calls, and summary workshop to review findings. Recommendations made through this process were drafted by the panel chair and circulated twice for additional panel comments. Conclusions. -- Treatment completion rates for pulmonary tuberculosis are most likely to exceed 90%, as recommended by the Centers for Disease Control and Prevention, when treatment is based on a patient-centered approach using directly observed therapy with multiple enablers and enhancers. Other less intensive interventions, including nonsupervised strategies and modified approaches to directly observed therapy, are unlikely to achieve this recommended treatment completion goal. Directly observed therapy also appears to be cost-effective compared with self-administered therapy, although data on cost-effectiveness are limited. JAMA 1998;279:943-948

SYNOPSIS Objective. To identify case characteristics and trends in the incidence of pediatric tuberculosis (TB) in Maryland during the national resurgence of the disease. Methods. The authors conducted a retrospective […]

The use of community-based directly observed therapy (DOT) for tuberculosis (TB) appears to control the incidence of tuberculosis in cities with high case rates. Directly observed therapy involves watching the patient take the medication in his home, workplace, school, clinic, or other designated location, and complete treatment. Researchers studied TB case rates in Baltimore from 1981 to 1992 and compared those rates to five other major US cities which did not have DOT programs. Baltimore's incidence of TB declined 29%, which was the greatest decrease among the cities studied. TB incidence in Baltimore decreased from 35.6 cases per 100,000 people in 1981 to 17.2 cases per 100,000 in 1992. Baltimore, which had ranked sixth place nationwide for TB cases in 1981 dropped to 28th in 1992, even though the city's AIDS case rate increased 171.5% from 1987 to 1992, the largest AIDS case increase of the five cities. HIV, AIDS, poverty, and injection drug use are considered risk factors for contracting TB.

Graduates of the University of Nebraska's medical school preceptorship program, in which students choose their preceptors from rural sites and are exposed to the social and economic aspects of rural practice, were surveyed after entering private practice about the program's effects on them. (MSE)

Background: Syringe exchange programs (SEP) reduce HIV incidence associated with injection drug use (IDU), but legislation often prohibits implementation. We examined the policy change impact allowing for SEP implementation on HIV diagnoses among people who inject drugs in 2 US cities., Setting: Philadelphia, PA, and Baltimore, MD., Methods: Using surveillance data from Philadelphia (1984-2015) and Baltimore (1985-2013) for IDU-associated HIV diagnoses, we used autoregressive integrated moving averages modeling to conduct 2 tests to measure policy change impact. We forecast the number of expected HIV diagnoses per city had policy not changed in the 10 years after implementation and compared it with the number of observed diagnoses postpolicy change, obtaining an estimate for averted HIV diagnoses. We then used interrupted time series analysis to assess the immediate step and trajectory impact of policy change implementation on IDU-attributable HIV diagnoses., Results: The Philadelphia (1993-2002) model predicted 15,248 new IDU-associated HIV diagnoses versus 4656 observed diagnoses, yielding 10,592 averted HIV diagnoses over 10 years. The Baltimore model (1995-2004) predicted 7263 IDU-associated HIV diagnoses versus 5372 observed diagnoses, yielding 1891 averted HIV diagnoses over 10 years. Considering program expenses and conservative estimates of public sector savings, the 1-year return on investment in SEPs remains high: $243.4 M (Philadelphia) and $62.4 M (Baltimore)., Conclusions: Policy change is an effective structural intervention with substantial public health and societal benefits, including reduced HIV diagnoses among people who inject drugs and significant cost savings to publicly funded HIV care.