里约热内卢市直接观察治疗的治疗成功率有所提高。
Improvements in treatment success rates with directly observed therapy in Rio de Janeiro City.
作者信息
Soares E C C, Pacheco A G F, Mello F C Q, Durovni B, Chaisson R E, Cavalcante S C
机构信息
Tuberculosis Control Programme, Communicable Diseases Coordination, Health Secretariat of Rio de Janeiro City, Brazil.
出版信息
Int J Tuberc Lung Dis. 2006 Jun;10(6):690-5.
SETTING
Rio de Janeiro City, Brazil.
OBJECTIVE
To evaluate the effect of directly observed therapy (DOT) on treatment success, by comparing the treatment success rates between patients treated under DOT with those who received self-administered therapy (SAT).
DESIGN
A longitudinal study in a cohort of tuberculosis (TB) patients. Of 9929 new pulmonary TB cases, 1190 (12%) were treated under DOT and 8739 (88%) under SAT. All patients received a three-drug regimen consisting of rifampicin (RMP), isoniazid (INH) and pyrazinamide for 2 months followed by 4 months of RMP and INH.
RESULTS
Patients under DOT were more likely to convert to sputum-negative at the end of the second month than those treated under SAT (86.3% vs. 61.9%, P < 0.001). DOT alone was significantly associated with successful treatment (OR 1.6, 95%CI 1.37-1.86, P < 0.001), even when controlled by sex, age and positive smear or culture at enrollment (OR 1.56, 95%CI 1.33-1.82, P < 0.001).
CONCLUSION
This pilot DOTS implementation phase showed that DOT is highly effective and feasible in a large urban centre of a developing country.
背景
巴西里约热内卢市。
目的
通过比较直接观察治疗（DOT）组与自我给药治疗（SAT）组患者的治疗成功率，评估直接观察治疗对治疗成功的影响。
设计
一项针对肺结核（TB）患者队列的纵向研究。在9929例新发肺结核病例中，1190例（12%）接受DOT治疗，8739例（88%）接受SAT治疗。所有患者均接受由利福平（RMP）、异烟肼（INH）和吡嗪酰胺组成的三联药物方案治疗2个月，随后接受4个月的RMP和INH治疗。
结果
在第二个月末，接受DOT治疗的患者比接受SAT治疗的患者更有可能痰菌转阴（86.3%对61.9%，P<0.001）。即使在按性别、年龄以及入组时涂片或培养阳性进行校正后，单独的DOT与治疗成功显著相关（比值比1.6，95%置信区间1.37 - 1.86，P<0.001）（比值比1.56，95%置信区间1.33 - 1.82，P<0.001）。
结论
这个直接观察短程治疗（DOTS）实施试点阶段表明，在发展中国家的一个大型城市中心，DOT是高度有效且可行的。
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