To address the vexing problem of treatment completion for tuberculosis patients, the Baltimore City Health Department (BCHD) in 1981 implemented a community outreach strategy employing directly observed therapy (DOT). By 1995, the incidence of tuberculosis in Baltimore had declined 61.7%. This BCHD program has reduced the need for patient incentives by providing nearly 90% of all DOT at either the patient's home, workplace or school; or drug treatment facility, city jail, or nursing home. Today, the proportion of all TB cases in Baltimore receiving DOT through the program approaches 90%, treatment completion rates exceed 90%, sputum-conversion rates among DOT- managed cases are nearly double the rates of privately treated cases, and drug resistant organisms remain rare (0.57% of all isolates, 1989-1993). This article describes the interworkings of this community-based program.
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine