[Results and epidemiological impact of directly observed treatment of tuberculosis]

To analyze the results and epidemiological impact on tuberculosis (TB) of directly observed therapy (DOT) for uncooperative patients.

Retrospective study of the case histories of patients admitted to the DOT unit in Catalonia (Spain) since its March 1993 inauguration until August 1998.

Of a total of 470 patients, 102 were cared for during the unit's first phase, in which funding resources were insufficient. Of the 368 admitted during the second phase beginning January 1996; 176 (47.5%) were cured, 27 (7.3%) died, 72 (19.5%) were still at the unit and 93 (25.2%) left the unit before completing treatment. Of the last group, 25 were cured, 31 died 19 continued DOT and 18 (4.9% of all enrolled in the second phase) were lost to follow-up. Thus, the final outcome distribution for the patients was 201 (54.6%) cured, 58 (15.7% died, 91 (24.7%) still in DOT and 18 (4.9%) lost to follow-up. The compliance rate during the second phase was 91.8%. These results may have contributed significantly to the nearly 30% reduction in the incidence of TB in Catalonia between 1992 and 1997, a period which saw large decreases in the number of cases among 20-to-44-year-olds (33%) and consequently also among under-15-year-olds (55%). Likewise the number of cases of TB in high risk groups decreased, 55% on the average with a minimum decrease of 40.1% among AIDS patients and a maximum decrease of 85.2% among indigents.

DOT has proven highly effective both for patients and for the community, although many other factors must also be considered when accounting for the current epidemiological trend.