INT J TUBERC LUNG DIS 16(4):462–467
© 2012 The Union
http://dx.doi.org/10.5588/ijtld.11.0121
Increasing directly observed therapy related to improved
tuberculosis treatment outcomes in Taiwan
E. Bloss,* P-C. Chan,† N-W. Cheng,* K-F. Wang,† S-L. Yang,† P. Cegielski*
* US Centers for Disease Control and Prevention, Atlanta, Georgia, USA; † Taiwan Centers for Disease Control,
Taipei, Taiwan
SETTING: Directly observed therapy (DOT) is a core el-
ement of tuberculosis (TB) care and control efforts. In
Taiwan, DOT was implemented in 2006, when the Stop
TB Strategy was adopted as a national policy.
O B J E C T I V E : To quantify DOT among patients on anti-
tuberculosis treatment and measure the association be-
tween proportion of DOT and TB treatment outcomes
at a national level in Taiwan.
D E S I G N : We analyzed data prospectively collected on all
new pulmonary TB cases reported to the national Web-
based registry between 1 January 2007 and 30 June 2008.
We compared treatment outcomes and proportion of
DOT in multivariable analyses.
R E S U LT S : Among 11 528 patients initiating anti-tuber-
culosis treatment, the proportion of days during which
TO ADDRESS the growing global burden of tuber-
culosis (TB), a six-point Stop TB strategy was intro-
duced in 2006,1,2 which includes high-quality DOTS
enhancement and expansion as one of its key ele-
ments. Directly observed therapy (DOT) using stan-
dardized short-course chemotherapy is one of the
recommended interventions to improve treatment
adherence and help achieve the World Health Organi-
zation (WHO) recommended target of 85% treatment
success among new sputum smear-positive cases.1,3,4
In 2007, 5.5 million TB cases were notified by
DOTS programs, and the target for treatment success
rate was reached globally in 2006.5 However, due to
its duration, side effects and the need for frequent
clinic visits, anti-tuberculosis treatment continues to
challenge health care providers worldwide.6 These
challenges often lead to non-adherence, compromis-
ing treatment effectiveness and leading to treatment
failure and mortality.
DOT can be defined as a trained person directly ob-
serving a patient swallowing anti-tuberculosis medi-
cations to ensure the prescribed treatment is taken on
schedule.7,8 DOT is intended to help patients take
Correspondence to: Emily Bloss, Division of Tuberculosis Elimination, International Research and Programs Branch, CDC,
1600 Clifton Road, MS E-10, Atlanta, GA 30333, USA. Tel: (+1) 404 639 2658. Fax: (+1) 404 639 1566. e-mail: dpu2@
cdc.gov
Article submitted 18 February 2011. Final version accepted 19 October 2011.
SUMMARY
an official DOT observer witnessed treatment was >60%
for 5150 (45%) patients and ⩽60% for 4601 (40%) pa-
tients, whereas for 1777 (15%) patients no days of DOT
were recorded. Being older, male, having positive bacte-
riology results and a non-World Health Organization
recommended treatment regimen at baseline were inde-
pendently related to unsuccessful treatment outcomes
and mortality. A dose-response effect was found between
proportion of DOT and these outcomes.
C O N C L U S I O N : These findings highlight the importance
of ensuring universal DOT in improving treatment out-
comes among new pulmonary TB patients.
K E Y W O R D S : tuberculosis; directly observed therapy;
treatment outcomes; Taiwan
their medication regularly and complete treatment,
thereby achieving cure and preventing drug resis-
tance. DOT has been associated with improved treat-
ment outcomes.9–11 However, other studies have
questioned the efficacy and necessity of DOT,12,13 or
have proposed a reduction in the frequency of obser-
vation.14 A meta-analysis by Volmink and Garner
found that DOT did not lead to better outcomes than
self-administered treatment in controlled trials.15 De-
spite these different conclusions, DOT is generally ac-
cepted as an effective core element of TB care and
control.9 However, many health care providers resist
implementing it. To help inform TB care and control
efforts in Taiwan, we sought to quantify DOT at the
patient level and evaluate the association between
proportion of DOT and treatment outcomes using
prospectively collected data at a national level.
METHODS
Setting and patient population
In Taiwan, TB remains the most common notifiable
infectious disease, with 14 265 cases reported and an

estimated incidence of 62 per 100 000 population in
2008.16 As part of the Stop TB strategy, the DOT pro-
gram was adopted in Taiwan in April 2006, and has
been implemented in all 25 city and county health de-
partments. Within 1 year, approximately one third of
TB patients received treatment via DOT in the public
and private sectors.17 The proportion of cases com-
pleting treatment nationally increased from 64% to
67% from 2005 to 2006, and in 2006 the treatment
success rate for DOT cases (75%) was higher than
for non-DOT cases (52%).18 However, despite this
positive trend, these findings do not control for other
factors that may have influenced outcomes.
In Taiwan, once a TB case is verified, the patient is
invited to participate in the DOT program, and among
those who agree, an official DOT observer is assigned
to the patient.19 DOT observers are required to have
9 years of education and DOT training, and are closely
supervised by a public health nurse. Approximately
500 trained DOT observers are responsible for 5–
20 TB patients each, monitoring the ingestion of anti-
tuberculosis medications during home visits or at a
health facility at least five times per week, monitoring
for adverse events and treatment complications, pro-
viding patients with food coupons as incentives and
entering their progress daily into an electronic Web-
based national registry, the National Surveillance Net-
work of Communicable Disease (NSNCD).
Data collection
All TB cases, both suspected and confirmed, are noti-
fiable by law to the Taiwan Centers for Disease Con-
trol (CDC) via the NSNCD. Standardized demo-
graphic, clinical, bacteriological and treatment data
are entered directly into the national database by pub-
lic health staff from routine medical and laboratory
records. Information on DOT and treatment out-
comes is also recorded in the NSNCD.
This analysis underwent ethical review by the US
CDC; it was determined to be a program evaluation
activity, not human subjects research.
Definitions
A patient was classified as a DOT case if he/she had
been evaluated by a treating physician, signed a writ-
ten consent form and had an official DOT observer
witness the ingestion of anti-tuberculosis medicines,
as documented in the NSNCD. We defined percent-
age of days on DOT as the number of days of DOT
by a DOT observer recorded in the daily log divided
by the total number of days on treatment. In cases
where a patient had more than one daily log entry
for DOT in one day, we counted one visit per day in
the calculation. We categorized this variable into
three groups—zero DOT, between zero and 60%,
and >60% DOT—based on the median percentage
(60.6%) for those with any DOT. Patients’ outcomes
were classified according to WHO categories.20 Suc-
DOT and treatment outcomes in Taiwan 463
cessful treatment outcomes included cure and treat-
ment completion; unsuccessful outcomes included
failure, death and default.
Data analysis
We restricted our analysis to all new pulmonary pa-
tients who initiated anti-tuberculosis treatment and
were reported to the CDC Taiwan via the national
Web-based registry between 1 January 2007 and
30 June 2008. Patients previously treated for TB were
excluded, as were patients with multidrug-resistant
TB (MDR-TB), as they are known to have markedly
different outcomes.21 We also excluded patients diag-
nosed with extra-pulmonary TB, as their treatment
regimen, duration and outcomes vary based on the
site of the disease.20 Cases were excluded if the pa-
tient was still on treatment or transferred out of the
country, if the TB diagnosis was excluded after regis-
tration, or if data for treatment days or outcomes
were missing.
Data were extracted from the national TB registry
and managed and analyzed using SAS 9.2 (SAS Insti-
tute, Cary, NC, USA). The characteristics of patients
receiving different proportions of DOT (>60%,
⩽60% and no DOT) were compared using the χ2 test
for categorical variables, and analysis of variance and
t-test for continuous variables; statistical significance
was defined as P < 0.05. The association between
DOT and treatment outcomes at the end of 12 months
was examined using multivariate analyses. Factors
were entered into models based on biological plausi-
bility, previous literature and statistical significance
in bivariate analysis. Colinearity and interactions were
assessed. Stepwise logistic regression was used to con-
struct a model to control for covariates associated
with DOT and unsuccessful treatment outcomes, us-
ing odds ratios (ORs) and 95% confidence intervals
(CIs). We used the Hosmer-Lemeshow test to evalu-
ate goodness-of-fit and the likelihood ratio test to
select the best fitting models. A multivariable Cox
proportional hazards model was used to assess the
independent relationship between proportion of DOT
and mortality.
RESULTS
Study population
Among 12 867 new consenting TB cases documented
as being part of the DOT program in the national TB
registry and starting treatment between 1 January
2007 and 30 June 2008, 1339 were excluded: 101
with extra-pulmonary disease, 173 with drug resis-
tance, 176 with missing days on treatment, 5 who
moved out of the country, 221 who did not have TB
and 760 who were still on treatment or had no treat-
ment outcomes recorded at the end of 12 months
(some cases had more than one exclusion criteria). A
total of 11 528 cases remained in the analysis. The
464 The International Journal of Tuberculosis and Lung Disease

majority were male (72%), and the median age was
67 years (range 1–96).
Directly observed therapy
Among 11 528 patients initiating treatment, the per-
centage of days on which they received DOT was
>60% for 5150 (45%), ⩽60% for 4601 (40%)
and zero for 1777 (15%; Table 1). A greater propor-
tion of cases with no DOT were older, male or ini-
tially treated with a non-WHO-recommended regi-
men. DOT was significantly associated with smear
and culture status and cavitary disease, indicators of
disease severity at the time of diagnosis. Specifically,
patients with no DOT had the highest proportions of
both positive smear and culture, and patients receiv-
ing any DOT were more likely to have cavitary dis-
ease than those with no DOT. More DOT was associ-
ated with any report of an adverse event, specifically
nausea or vomiting, during treatment, whereas num-
ber of hospitalizations was higher in patients with
less or no DOT. The median number of days on treat-
ment was 205 (range 8–365) for >60% DOT, 210
(range 6–365) for ⩽60% DOT and 68 (range 0–365)
for no DOT.
Treatment outcomes
Proportion of DOT was strongly associated with
treatment outcomes. Among patients with unsuccess-
ful outcomes, respectively 5%, 40% and 55% had
>60% DOT, ⩽60% DOT and no DOT (P < 0.0001;
Table 2). All socio-demographic, diagnostic and treat-
ment characteristics in Table 2 were statistically sig-
nificant in their bivariate associations with treatment
outcomes. The median number of days on treatment
was 215 (range 154–365) for those with successful
outcomes and 60 (range 0–365) for those with un-
successful outcomes (P < 0.0001).
In the multivariable logistic regression model, com-
pared with patients who had >60% DOT, patients
who received no DOT were much more likely to have
unsuccessful treatment outcomes after 12 months (ad-
justed OR [aOR] 73.1, 95%CI 58.9–90.6) (Table 2).

Table 1 Characteristics of new pulmonary tuberculosis patients by proportion of DOT*

>60% DOT ⩽60% DOT No DOT Total
(n = 5150) (n = 4601) (n = 1777) (N = 11 528)
Characteristic n (%) n (%) n (%) n (%)
Socio-demographic
Age at diagnosis, years
⩽24 360 (7.0) 295 (6.4) 20 (1.1) 675 (5.9)
25–44 908 (17.6) 737 (16.0) 105 (5.9) 1 750 (15.2)
45–64 1501 (29.2) 1165 (25.3) 325 (18.3) 2 991 (25.9)
⩾65 2381 (46.2) 2404 (52.3) 1327 (74.7) 6 112 (53.0)
Sex
Female 1554 (30.2) 1288 (28.0) 438 (24.7) 3 280 (28.5)
Male 3596 (69.8) 3313 (72.0) 1339 (75.3) 8 248 (71.5)
Living in a mountainous region†
No 4952 (96.2) 4372 (95.0) 1755 (98.8) 11 079 (96.1)
Yes 198 (3.8) 229 (5.0) 22 (1.2) 449 (3.9)
Diagnosis
Bacteriology results
Smear- and culture-negative 125 (2.4) 340 (7.4) 32 (1.8) 497 (4.4)
Smear- and culture-positive 3119 (60.9) 2337 (51.2) 1067 (61.2) 6 523 (57.0)
Smear- or culture-positive 1880 (36.7) 1890 (41.4) 644 (37.0) 4 414 (38.6)
Cavitary disease
Normal CXR 117 (2.3) 105 (2.3) 57 (3.2) 279 (2.4)
Abnormal CXR and no cavity present 3666 (71.9) 3376 (74.0) 1396 (79.4) 8 438 (73.9)
Abnormal CXR and cavity present 1313 (25.8) 1081 (23.7) 306 (17.4) 2 700 (23.7)
Treatment
Initial treatment prescribed
Other regimens 573 (11.1) 690 (15.0) 439 (24.7) 1 702 (14.8)
WHO-recommended regimen 4577 (88.9) 3911 (85.0) 1338 (75.3) 9 826 (85.2)
Any report of adverse event
No 4517 (87.7) 4094 (89.0) 1741 (98.0) 10 352 (89.8)
Yes 633 (12.3) 507 (11.0) 36 (2.0) 1 176 (10.2)
Number of hospitalizations during treatment
0 2867 (55.7) 1374 (29.9) 172 (10.0) 4 413 (38.5)
1 2015 (39.1) 2044 (44.5) 1229 (71.4) 5 288 (46.1)
⩾2 267 (5.2) 1175 (25.6) 321 (18.6) 1 763 (15.4)
Treatment outcome at end of 1 year
Unsuccessful treatment 116 (2.3) 877 (19.1) 1191 (67.0) 2 184 (19.0)
Successful treatment 5034 (97.8) 3724 (80.9) 586 (33.0) 9 344 (81.0)
* All socio-demographic, diagnostic and treatment characteristics in Table 1 are significant in bivariate associations with DOT based on the χ2 test (P < 0.05).
Cell counts do not always sum to column total due to missing data. Missing data were excluded when missing data for all of the cell percentages across all
categories comprised <2%.
† Proxy measure for indigenous populations and hard-to-reach areas.

DOT = directly observed therapy; CXR = chest radiograph.

 DOT and treatment outcomes in Taiwan 465

Table 2 Factors associated with unsuccessful treatment outcomes in bivariate analysis and the multivariate logistic regression
model (N = 11 528)*
Successful Unsuccessful
treatment treatment
(n = 9344) (n = 2184)
Characteristic n (%) n (%) OR (95%CI) aOR (95%CI)
Age at diagnosis, years
⩽24 664 (7.1) 11 (0.5) 1.0 1.0
25–44 1662 (17.8) 88 (4.0) 3.2 (1.7–6.0) 2.5 (1.3–4.8)
45–64 2676 (28.6) 315 (14.4) 7.1 (3.9–13.0) 4.7 (2.5–8.9)
⩾65 4342 (46.5) 1770 (81.1) 24.6 (13.5–44.8) 15.1 (8.2–27.8)
Sex
Female 2745 (29.4) 535 (24.5) 1.0 1.0
Male 6599 (70.6) 1649 (75.5) 1.3 (1.2–1.4) 1.2 (1.1–1.4)
Living in a mountainous region
No 8945 (95.7) 2134 (97.7) 1.0
Yes 399 (4.3) 50 (2.3) 0.5 (0.4–0.7)
Bacteriology results
Smear- and culture-negative 438 (4.7) 59 (2.8) 1.0 1.0
Smear- and culture-positive 5241 (56.4) 1282 (59.8) 1.8 (1.4–2.4) 2.0 (1.5–2.7)
Smear- or culture-positive 3613 (38.9) 801 (37.4) 1.6 (1.2–2.2) 1.5 (1.1–2.0)
Cavitary disease
Normal CXR 223 (2.4) 56 (2.6) 1.0
Abnormal CXR and no cavity present 6688 (72.3) 1750 (80.8) 1.0 (0.8–1.4)
Abnormal CXR and cavity present 2341 (25.3) 359 (16.6) 0.6 (0.5–0.8)
Initial treatment prescribed
Other regimens 1172 (12.5) 530 (24.3) 1.0 1.0
WHO-recommended regimen 8172 (87.5) 1654 (75.7) 0.5 (0.4–0.5) 0.7 (0.6–0.8)
Any report of adverse event
No 8291 (88.7) 2061 (94.4) 1.0
Yes 1053 (11.3) 123 (5.6) 0.5 (0.4–0.6)
Number of hospitalizations during treatment
0 4198 (44.9) 215 (10.1) 1.0
1 3936 (42.1) 1352 (63.8) 6.7 (5.8–7.8)
⩾2 1210 (13.0) 553 (26.1) 8.9 (7.5–10.6)
Proportion of days of DOT
>60% DOT 5034 (53.9) 116 (5.3) 1.0 1.0
⩽60% DOT 3724 (39.9) 877 (40.2) 10.2 (8.4–12.5) 10.7 (8.7–13.2)
No DOT 586 (6.3) 1191 (54.5) 88.2 (71.6–108.7) 73.1 (58.9–90.6)
* All socio-demographic, diagnostic and treatment characteristics in Table 2 are significant in bivariate associations with DOT based on the χ2 test (P < 0.05).
Cell counts do not always sum to column total due to missing data. Missing data were excluded when missing data for all of the cell percentages across all
categories comprised <2%.
† Proxy measure for indigenous populations and hard-to-reach areas.

OR = odds ratio; aOR = adjusted OR; CI = confidence interval; CXR = chest radiograph; DOT = directly observed therapy.

The effect was similar, but less dramatic, for patients
with ⩽60% DOT (aOR 10.7, 95%CI 8.7–13.2). In-
creasing age, male sex and having a positive smear
and/or culture were associated with unsuccessful treat-
ment outcome, whereas having a WHO-recommended
initial treatment regimen was associated with suc-
cessful outcome.
To look for a threshold effect, we further exam-
ined the distribution of DOT by deciles; at approxi-
mately 40–50% DOT, 84% of TB cases achieved
treatment success, near the WHO target of 85% treat-
ment success.
Death during TB treatment occurred in 2030
(17.6%) patients. To evaluate the impact of early
deaths on unsuccessful outcomes, we excluded 344
(3%) patients who died during the first 2 weeks of
treatment from the logistic regression analysis. The
association between proportion of DOT and unsuc-
cessful treatment outcomes remained similar (no DOT:
aOR 53.7, 95%CI 43.1–66.8; ⩽60% DOT: aOR
10.6, 95%CI 8.7–13.1). In a proportional hazards
analysis, a similar dose-response effect was found be-
tween proportion of DOT and death, after control-
ling for age, sex, bacteriology results and initial treat-
ment. Receiving no DOT (adjusted hazard ratio [aHR]
53.9, 95%CI 43.0–67.4) and ⩽60% DOT (aHR 10.9,
95%CI 8.7–13.6) significantly increased the risk of
death compared with receiving >60% DOT.
DISCUSSION
In this national-level study, we quantified DOT for
each patient on anti-tuberculosis treatment in a large
programmatic setting. The most important factor
associated with treatment outcomes was proportion
of DOT. Among new pulmonary TB cases, a dose-
response effect was observed: increased DOT was
strongly associated with better treatment outcomes,
466 The International Journal of Tuberculosis and Lung Disease
after controlling for other factors. These findings high-
light the importance of DOT in improving treatment
outcomes in Taiwan. The provision of standardized
treatment with supervision and patient support is a
key component of the Stop TB strategy.1 DOT can
help ensure patients adhere to and complete lengthy
and complex TB treatment regimens. By reducing poor
treatment outcomes, such as default, DOT can ulti-
mately help to reduce the spread of infection, the risk
of acquired drug resistance and the development of
new cases.9,22 An important area of research would
be to examine the risk of recurrence among patients
with and without DOT in Taiwan.
Based on our criteria, among patients in the DOT
program initiating TB treatment, 15% did not have
any DOT recorded. These findings highlight the chal-
lenges faced by TB control programs when imple-
menting and widening the reach of DOT nation-
wide, while simultaneously maintaining high-quality
services in all sectors of society.23 A greater propor-
tion of patients who were older, male or who started
treatment with a non-standard regimen did not re-
ceive DOT. Understanding who is not receiving DOT
can help identify high-risk patients and ensure that
they receive additional treatment support. Innovative
strategies have been implemented in Taiwan to sup-
port TB patients and clinicians with DOT, including a
lottery program that rewards patients for taking their
medications by providing opportunities for monetary
incentives, and a remuneration scheme set up by the
Bureau of National Health Insurance for clinicians
treating TB patients.24
In addition to proportion of DOT during treatment,
other factors associated with poor treatment outcomes
in Taiwan were older age, male sex, having both a
positive smear and culture and receiving a non-WHO-
recommended regimen at baseline. These findings are
consistent with smaller studies from Taiwan that have
previously found that being older,25,26 male27 and
positive bacteriology at baseline27 are predictive of
poor treatment outcomes among pulmonary TB pa-
tients. Although data were only available for the initial
treatment regimen, it is not clear why, for almost
15% of cases, a non-WHO-recommended regimen
was used in Taiwan. However, these findings are sim-
ilar to a 2007 study in which up to 15% of regimens
were found not to comply with recommendations
to prescribe the standardized four drug regimen.28
In response, Taiwan CDC reduced reimbursements
for suboptimal regimens, and prescriptions of non-
standardized regimens fell to 5% in 2008.29
There were several limitations in this study. As
only TB cases reported to the NSNCD were included,
this analysis missed TB cases who were not registered
in the system. No formal evaluation was performed
to assess whether the DOT data in the NSNCD are
accurate. Furthermore, the absence of data does not
always signify the absence of services: it is possible
that DOT was provided to patients but not docu-
mented. Also, many patients do not receive DOT dur-
ing the weekends; at most they would receive DOT 5
out of 7 days per week (>71% of the time). The DOT
categorization used in this analysis would still clas-
sify these cases as >60%, and therefore our findings
are able to take this into account. As this was an ob-
servational study in a large programmatic setting, it
was not feasible to measure all confounders, includ-
ing some individual characteristics, such as alcohol
and drug use, and homelessness. Human immuno-
deficiency virus (HIV) status was not assessed; how-
ever, due to the small proportion (0.7%) of TB patients
estimated to have HIV infection in Taiwan, it is un-
likely that HIV status would have greatly influenced
the conclusions.30 Furthermore, we were unable to
evaluate the quality of care (e.g., DOT observer skills,
or relationship between DOT observer and patient).
In Taiwan, where DOT observers receive training and
close supervision and have a reasonable case load,
the quality of DOT is likely to influence outcomes, al-
though this was not assessed in this study.
A strength of this study is that it is a large,
national-level analysis examining the impact of DOT
on treatment outcomes in a programmatic setting
with sufficient sample size to control for potential
confounding and assess different criteria for the pro-
portion of DOT.
CONCLUSION
DOT is a practical and implementable approach with-
in the Stop TB strategy. Combined with strong politi-
cal commitment, including promotion of innovative
strategies that improve case notification and treat-
ment outcomes, and an exemplary information sys-
tem that tracks the progress of every patient and fa-
cilitates accountability and evaluation, such as those in
Taiwan, effective TB control is feasible.31 These find-
ings help to improve our understanding and highlight
the importance of ensuring universal DOT in Taiwan.
Disclaimer: The findings and conclusions in this report are those
of the authors and do not necessarily represent the official position
of the US Centers for Disease Control and Prevention.
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C O N T E X T E : Le traitement directement observé (DOT)
est un élément-clé du traitement de la tuberculose (TB)
et des efforts de lutte. A Taïwan, le DOT a été mis en
œuvre en 2006, moment où la stratégie Stop TB a été
adoptée comme politique nationale.
O B J E C T I F : Quantifier le DOT au niveau national chez
les patients sous traitement TB et mesurer l’association
entre la quantité de DOT et les résultats du traitement
TB.
S C H É M A : Nous avons analysé de manière prospective
les données colligées sur l’ensemble des nouveaux cas de
TB pulmonaire déclarés au registre national relié à in-
ternet entre le 1er janvier 2007 et le 30 juin 2008. Nous
avons comparé dans des analyses multivariées les résul-
tats du traitement et la quantité de DOT.
R É S U LTAT S : Parmi 11 528 patients commençant un
traitement de la TB, la proportion de jours pendant
MARCO DE REFERENCIA: El tratamiento directamente
observado (DOT) constituye un elemento central de los
programas de control y tratamiento de la tuberculosis
(TB). En Taiwán, el DOT se introdujo en el 2006 cuando
se adoptó la iniciativa Alto a la Tuberculosis como una
política nacional.
O B J E T I V O : Cuantificar la aplicación del DOT en los
pacientes que se encontraban en tratamiento antituber-
culoso y medir la correlación entre la cantidad de dosis
recibidas con DOT y los desenlaces terapéuticos a escala
nacional en Taiwán.
M É T O D O : Se analizaron de manera prospectiva los da-
tos recogidos sobre todos los casos nuevos de TB notifi-
cados por internet al registro nacional entre el 1° de en-
ero del 2007 y el 30 de junio del 2008. En los análisis
multifactoriales se compararon los desenlaces terapéuti-
cos y la proporción de dosis recibidas con DOT.
R E S U LTA D O S : En los 11 528 pacientes que iniciaron el
DOT and treatment outcomes in Taiwan i
RÉSUMÉ
lesquels un observateur officiel du DOT a été témoin du
traitement est > 60% chez 5150 patients (45%) et ⩽60%
chez 4601 patients (40%), alors que chez 1777 patients
(15%) aucun jour de traitement observé n’a été enregis-
tré. Les facteurs liés de manière indépendante à des ré-
sultats de traitement non couronnés de succès et à la
mortalité sont l’âge plus avancé, le sexe masculin, les ré-
sultats positifs de l’examen bactériologique et l’admini-
stration dès le début d’un régime de traitement non re-
commandé par l’Organisation Mondiale de la Santé. On
a trouvé un rapport dose-effet entre la proportion de
DOT et ces résultats.
C O N C L U S I O N : Ces observations soulignent l’impor-
tance d’assurer un DOT universel si l’on veut améliorer
les résultats du traitement chez les nouveaux patients at-
teints de TB pulmonaire.
RESUMEN
tratamiento antituberculoso, la proporción de días en
los cuales un observador oficial de DOT presenció la
administración del tratamiento fue >60% en 5150 pa-
cientes (45%) e ⩽60% en 4601 pacientes (40%), pero
en 1777 pacientes (15%) no se encontró el registro de
DOT. Los factores que se asociaron en forma indepen-
diente con el fracaso terapéutico y la mortalidad fueron
la ancianidad, el sexo masculino y en forma simultánea
haber tenido resultados bacteriológicos positivos y reci-
bido un tratamiento diferente del recomendado por la
Organización Mundial de la Salud al comienzo. Se en-
contró un efecto de dosis y respuesta entre la propor-
ción de la aplicación de DOT y estos desenlaces.
C O N C L U S I Ó N : Los resultados del presente estudio de-
stacan la importancia de la aplicación universal del DOT
en el mejoramiento de los desenlaces terapéuticos de los
casos nuevos de TB pulmonar.