Directly observed preventive therapy. Turning the tide against tuberculosis
M. R. Kohn, M. R. Arden, J. Vasilakis and I. R. Shenker
Department of Pediatrics, Schneider Children's Hospital, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY, USA.
OBJECTIVE: To compare compliance between directly observed preventive
therapy and daily treatment for students with inactive (class II)
tuberculosis. DESIGN: Cohort analytic study and cost-effectiveness
analysis. Students found to be positive for purified protein derivative and
having no abnormal chest x-ray films on mandated screening were advised to
have prophylactic treatment with isoniazid. Treatment was either directly
observed in the school health clinic or provided as daily therapy by the
Department of Health. Treatment completion, age, sex, ethnicity, and recent
immigration were compared between the 2 treatment groups. SETTING: A
school-based clinic at an inner-city New York, NY, high school. RESULTS: In
1993, 864 students were screened. The positive purified protein derivative
rate was 19.3%. All 161 students had negative findings on chest x-ray
films. Of the students, 105 (65.2%) were enrolled in the school-based
clinic directly observed preventive therapy program, 22 were referred to
the Department of Health for daily therapy, and 34 excluded from the study
before treatment. The 2 treatment groups did not differ in composition.
Completion of therapy in the directly observed preventive therapy group
(87.6%) was significantly greater than that in the daily therapy group
(50%) (P = 0.001, X2 = 11.8) and that reported in the literature for
programs other than directly observed preventive therapy (30%-70%).
Directly observed preventive therapy was administered by existing personnel
without additional expenditure. CONCLUSION: Directly observed preventive
therapy is an effective strategy that should be used in the school clinic
setting to increase compliance with prophylactic treatment for
tuberculosis.
