Does directly observed therapy (DOT) reduce drug resistant tuberculosis?

Patrick K. Moonan, Teresa N. Quitugua, Janice M. Pogoda, Gary Woo, Gerry Drewyer, Behzad Sahbazian, Denise Dunbar, Kenneth C. Jost, Charles Wallace, Stephen Weis

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Abstract

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.

Original languageEnglish
Article number19
JournalBMC Public Health
Volume11
DOIs
StatePublished - 11 Jan 2011

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Directly Observed Therapy
Multidrug-Resistant Tuberculosis
Tuberculosis
Odds Ratio
Confidence Intervals
Genotype
Observation
Likelihood Functions
Ethambutol
Isoniazid
Health
Rifampin
Restriction Fragment Length Polymorphisms
Pharmaceutical Preparations
Logistic Models

Cite this

Moonan, P. K., Quitugua, T. N., Pogoda, J. M., Woo, G., Drewyer, G., Sahbazian, B., ... Weis, S. (2011). Does directly observed therapy (DOT) reduce drug resistant tuberculosis? BMC Public Health, 11, [19]. https://doi.org/10.1186/1471-2458-11-19
Moonan, Patrick K. ; Quitugua, Teresa N. ; Pogoda, Janice M. ; Woo, Gary ; Drewyer, Gerry ; Sahbazian, Behzad ; Dunbar, Denise ; Jost, Kenneth C. ; Wallace, Charles ; Weis, Stephen. / Does directly observed therapy (DOT) reduce drug resistant tuberculosis?. In: BMC Public Health. 2011 ; Vol. 11.
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title = "Does directly observed therapy (DOT) reduce drug resistant tuberculosis?",
abstract = "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.",
author = "Moonan, {Patrick K.} and Quitugua, {Teresa N.} and Pogoda, {Janice M.} and Gary Woo and Gerry Drewyer and Behzad Sahbazian and Denise Dunbar and Jost, {Kenneth C.} and Charles Wallace and Stephen Weis",
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Moonan, PK, Quitugua, TN, Pogoda, JM, Woo, G, Drewyer, G, Sahbazian, B, Dunbar, D, Jost, KC, Wallace, C & Weis, S 2011, 'Does directly observed therapy (DOT) reduce drug resistant tuberculosis?', BMC Public Health, vol. 11, 19. https://doi.org/10.1186/1471-2458-11-19

Does directly observed therapy (DOT) reduce drug resistant tuberculosis? / Moonan, Patrick K.; Quitugua, Teresa N.; Pogoda, Janice M.; Woo, Gary; Drewyer, Gerry; Sahbazian, Behzad; Dunbar, Denise; Jost, Kenneth C.; Wallace, Charles; Weis, Stephen.

In: BMC Public Health, Vol. 11, 19, 11.01.2011.

Research output: Contribution to journalArticleResearchpeer-review

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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

PY - 2011/1/11

Y1 - 2011/1/11

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.

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Moonan PK, Quitugua TN, Pogoda JM, Woo G, Drewyer G, Sahbazian B et al. Does directly observed therapy (DOT) reduce drug resistant tuberculosis? BMC Public Health. 2011 Jan 11;11. 19. https://doi.org/10.1186/1471-2458-11-19