TY - JOUR
T1 - Does directly observed therapy (DOT) reduce drug resistant tuberculosis?
AU - Moonan, Patrick K.
AU - Quitugua, Teresa N.
AU - Pogoda, Janice M.
AU - Woo, Gary
AU - Drewyer, Gerry
AU - Sahbazian, Behzad
AU - Dunbar, Denise
AU - Jost, Kenneth C.
AU - Wallace, Charles
AU - Weis, Stephen E.
N1 - Funding Information:
The authors acknowledge editorial assistance of Thaddeus Miller and the manuscript review and suggestions by Francesca Sanchez M.D and Peter Barnes M.D. This work was supported in part by the Robert J. and Helen C. Kleberg Foundation, by CDC Tuberculosis Trials and Epidemiologic Studies Consortium and cooperative agreements between the CDC National Tuberculosis Genotyping and Surveillance Network and the Texas Department of State Health Services.
PY - 2011
Y1 - 2011
N2 - Background: Directly observed therapy (DOT) is a widely recommended and promoted strategy to manage tuberculosis (TB), however, there is still disagreement about the role of DOT in TB control and the impact it has on reducing the acquisition and transmission of drug resistant TB. This study compares the portion of drug resistant genotype clusters, representing recent transmission, within and between communities implementing programs differing only in their directly observed therapy (DOT) practices. Methods. Genotype clusters were defined as 2 or more patient members with matching IS6110 restriction fragment length polymorphism (RFLP) and spoligotype patterns from all culture-positive tuberculosis cases diagnosed between January 1, 1995 and December 31, 2001. Logistic regression was used to compute maximum-likelihood estimates of odds ratios (ORs) and 95% confidence intervals (CIs) comparing cluster members with and without drug resistant isolates. In the universal DOT county, all patients received doses under direct observation of health department staff; whereas in selective DOT county, the majority of received patients doses under direct observation of health department staff, while some were able to self-administer doses. Results: Isolates from 1,706 persons collected during 1,721 episodes of tuberculosis were genotyped. Cluster members from the selective DOT county were more than twice as likely than cluster members from the universal DOT county to have at least one isolate resistant to isoniazid, rifampin, and/or ethambutol (OR = 2.3, 95% CI: 1.7, 3.1). Selective DOT county isolates were nearly 5 times more likely than universal DOT county isolates to belong to clusters with at least 2 resistant isolates having identical resistance patterns (OR = 4.7, 95% CI: 2.9, 7.6). Conclusions: Universal DOT for tuberculosis is associated with a decrease in the acquisition and transmission of resistant tuberculosis.
AB - Background: Directly observed therapy (DOT) is a widely recommended and promoted strategy to manage tuberculosis (TB), however, there is still disagreement about the role of DOT in TB control and the impact it has on reducing the acquisition and transmission of drug resistant TB. This study compares the portion of drug resistant genotype clusters, representing recent transmission, within and between communities implementing programs differing only in their directly observed therapy (DOT) practices. Methods. Genotype clusters were defined as 2 or more patient members with matching IS6110 restriction fragment length polymorphism (RFLP) and spoligotype patterns from all culture-positive tuberculosis cases diagnosed between January 1, 1995 and December 31, 2001. Logistic regression was used to compute maximum-likelihood estimates of odds ratios (ORs) and 95% confidence intervals (CIs) comparing cluster members with and without drug resistant isolates. In the universal DOT county, all patients received doses under direct observation of health department staff; whereas in selective DOT county, the majority of received patients doses under direct observation of health department staff, while some were able to self-administer doses. Results: Isolates from 1,706 persons collected during 1,721 episodes of tuberculosis were genotyped. Cluster members from the selective DOT county were more than twice as likely than cluster members from the universal DOT county to have at least one isolate resistant to isoniazid, rifampin, and/or ethambutol (OR = 2.3, 95% CI: 1.7, 3.1). Selective DOT county isolates were nearly 5 times more likely than universal DOT county isolates to belong to clusters with at least 2 resistant isolates having identical resistance patterns (OR = 4.7, 95% CI: 2.9, 7.6). Conclusions: Universal DOT for tuberculosis is associated with a decrease in the acquisition and transmission of resistant tuberculosis.
UR - http://www.scopus.com/inward/record.url?scp=78650940044&partnerID=8YFLogxK
U2 - 10.1186/1471-2458-11-19
DO - 10.1186/1471-2458-11-19
M3 - Article
C2 - 21214913
AN - SCOPUS:78650940044
SN - 1471-2458
VL - 11
JO - BMC Public Health
JF - BMC Public Health
M1 - 19
ER -