ASSESSMENT OF THE IMPACT OF DIRECTLY OBSERVED THERAPY ON TREATMENT OUTCOMES OF TUBERCULOSIS PATIENTS IN JOS, PLATEAU STATE

Abstract

INTRODUCTION
Tuberculosis is a major public Health problem in Nigeria as well as in many developing countries. The World Health Organization (WHO) declared tuberculosis as a global emergency in 1993 and thereafter adopted the directly observed treatment short course strategy (DOTS) to tackle the problem. The directly observed treatment component (DOT) of the strategy is meant to improve treatment completion and outcome.
OBJECTIVES
The objective of this study was to determine and compare treatment outcomes in patients on directly observed therapy (DOT) and self-administered therapy (SAT), and to determine the relationship between treatment outcomes and sociodemographic characteristic/HIV infection.
METHODS
This was a randomized follow-up study. The study population consisted of newly diagnosed smear-positive tuberculosis patients aged 15years and above in five centers in Jos and environs. Patients were recruited consecutively and then randomly assigned (by balloting) to directly observed therapy (DOT) group and self-administered therapy (SAT) group as control and both had the WHO recommended short course chemotherapy (SCC).
RESULTS
Sputum conversion rate at the end of two months of therapy was 94.3% in the DOT group and 91.8% in the SAT group. The difference was not statistically significant meaning that DOT does not offer extra advantage in sputum conversion at the end of two months of therapy. Patients on directly observed therapy and self-administered therapy had cure rates of 80% and 67.3% respectively. The difference was statistically significant (P0.05), implying that DOT is more effective than SAT in terms of overall treatment success rate. Default rate was 19.1% in self – administered group and 9% in the DOT group. The difference was
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statistically significant (P0.05). This means that patients on SAT are more likely to default from treatment than those on DOT. In the DOT group, death rate, treatment failure rate and transfer out were 7.3%, 1.8% and 1.8% respectively and 6.4%, 2.7% and 4.5% respectively in the SAT group. HIV infection, alcohol abuse and age group 15 – 34years had statistically significant relationship with treatment outcome while sex, employment, literacy level and cost of transportation did not.
CONCLUSION
The directly observed therapy component of DOTS had positive impact on treatment outcome of tuberculosis patients. Therefore the use of DOT as a component of DOTS should be promoted in tuberculosis control in this environment. More attention should be given to HIV control in order to ensure high success rate of TB therapy.