Approaches to improving adherence to antituberculosis therapy--South Carolina and New York, 1986-1991

Patients with tuberculosis (TB) who fail to complete a standard course of antituberculosis (anti-TB) therapy are at increased risk for treatment failure and may play a role in both the emergence of drug-resistant strains of Mycobacterium tuberculosis and further spread of TB. During 1986-1991, the South Carolina Department of Health and Environmental Control and the New York City Department of Health (NYCDH) attempted to improve patient adherence to anti-TB therapy by employing a combination of strategies that included incentives, directly observed therapy (DOT) (i.e., health-care worker observation of the patient ingesting each dose of medication), court-ordered DOT, and commitment for inpatient management. This report describes the experiences of selected strategies in South Carolina and New York City and provides recommendations for improving patient adherence to anti-TB therapy.