Zoë M McLaren|Amanda A. Milliken|Amanda Meyer|Alana Sharp
Does directly observed therapy improve tuberculosis treatment? More evidence is needed to guide tuberculosis policy
University of Michigan–Ann Arbor|University of Michigan–Ann Arbor|University of Michigan–Ann Arbor|University of Michigan–Ann Arbor
tuberculosis tb ranks alongside hiv leading infectious disease cause death worldwide incurs global economic burden 12 billion annually directly observed therapy dot recommends tb patients complete course treatment direct observation treatment supporter trained overseen health services ensure patients take drugs scheduled though current end tb strategy mention dot supportive treatment supervision treatment partners many tb programs still use despite fact demonstrated statistically significantly superior selfadministered treatment ensuring treatment success cure dot designed promote proper adherence full course drug therapy order improve patient outcomes prevent development drug resistance yet 8 billion dollars spent tb treatment year thousands undergo dot part course treatment despite absence rigorous evidence supporting superior effectiveness dot selfadministration achieving drug susceptible tb dstb cure moreover dot component burdens patients financial opportunity costs potential intensified stigma rigorously evaluate effectiveness dot identify essential contributors successful treatment minimized patient burden call pragmatic experimental trial conducted realworld program settings gold standard evidencebased health policy decisions time invest rigorous evaluation dot reevaluate dot requirement tb treatment worldwide rigorously evaluating choice treatment supporter frequency health care worker contact development new educational materials realworld setting would build evidence base inform optimal design tb treatment protocol implementing patientcentered approach may wise reallocation resources raise tb cure rates prevent relapse minimize emergence drug resistance maintaining status quo absence rigorous supportive evidence may diminish effectiveness tb control policies long run