Directly observed therapy in an inner city hospital

A directly observed therapy (DOT) tuberculosis (TB) program in a large urban teaching hospital in the East Harlem section of New York City.

In response to an emergent epidemic of TB, the State Department of Health mobilized a coalition of providers outside the public sector to provide DOT and medical care for people with TB, with the goal of treatment until cure. The results of the first 150 patients of one program are reviewed.

A multidisciplinary DOT team coordinated treatment at several sites within and without the institution, according to established medical regimens.

The program served a hard-to-reach population, 63% human immunodeficiency virus (HIV) positive, 64% substance users, 17% inadequately housed and 15% indigent. In the program's first three years there was 85% overall compliance with DOT visits. Using the completion of therapy index, 66% of patients completed therapy, 13% remained on treatment, 7% transferred to self medication and 1% were lost to follow up. No patient on DOT developed a drug resistant organism. There were no hospital readmissions for TB.

The experience of this program demonstrates the efficacy of an intensive, personalized DOT program in ensuring treatment until cure.