Programa de Controle da Tuberculose, Superintendência de Vigilância em Saúde, Secretaria de Estado de Saúde e Defesa Civil do Rio de Janeiro, Rio de Janeiro, Brasil.
Rev Saude Publica. 2011 Feb;45(1):40-8. doi: 10.1590/s0034-89102010005000055. Epub 2010 Dec 10.
To describe the implantation and the effects of directly-observed treatment short course (DOTS) in primary health care units.
Interviews were held with the staff of nine municipal health care units (MHU) that provided DOTS in Rio de Janeiro City, Southeastern Brazil, in 2004-2005. A dataset with records of all tuberculosis treatments beginning in 2004 in all municipal health care units was collected. Bivariate analyses and a multinomial model were applied to identify associations between treatment outcomes and demographic and treatment process variables, including being in DOTS or self-administered therapy (SAT).
From 4,598 tuberculosis cases treated in public health units administrated by the municipality, 1,118 (24.3%) were with DOTS and 3,480 (75.7%) with SAT. The odds of DOTS were higher among patients with age under 50 years, tuberculosis relapse and prior history of default or treatment failure. The odds of death were 52.0% higher among patients on DOTS as compared to SAT. DOTS modality including community health workers (CHWs) showed the highest treatment success rate. A reduction of 21.0% was observed in the odds of default (vs. cure) among patients on DOTS as compared to patients on SAT, and a reduction of 64.0% among patients on DOTS with CHWs as compared to those without CHWs.
Patients with a "low compliance profile" were more likely to be included in DOTS. This strategy improves the quality of care provided to tuberculosis patients, although the proposed goals were not achieved.
描述直接观察治疗短期疗程（DOTS）在基层医疗单位的实施和效果。
2004 年至 2005 年，对巴西东南部里约热内卢市提供 DOTS 的 9 个市立医疗单位的工作人员进行了访谈。收集了所有市立医疗单位自 2004 年开始的所有结核病治疗记录数据集。采用双变量分析和多项模型，确定治疗结果与人口统计学和治疗过程变量之间的关联，包括 DOTS 或自我管理治疗（SAT）。
在市立医疗机构管理的 4598 例结核病患者中，有 1118 例（24.3%）接受 DOTS 治疗，3480 例（75.7%）接受 SAT 治疗。年龄在 50 岁以下、结核病复发和既往有停药或治疗失败史的患者，DOTS 的可能性更高。与 SAT 相比，DOTS 组患者的死亡风险高出 52.0%。包括社区卫生工作者（CHW）在内的 DOTS 模式显示出最高的治疗成功率。与 SAT 相比，DOTS 组患者的停药（与治愈相比）的可能性降低了 21.0%，而 DOTS 组中有 CHW 的患者与没有 CHW 的患者相比，停药的可能性降低了 64.0%。
“低依从性”患者更有可能被纳入 DOTS。尽管没有达到预期目标，但这一策略提高了结核病患者的护理质量。
