Increasing directly observed therapy related to improved tuberculosis treatment outcomes in Taiwan.

SETTING: Directly observed therapy (DOT) is a core element of tuberculosis (TB) care and control efforts. In Taiwan, DOT was implemented in 2006, when the Stop TB Strategy was adopted as a national policy. OBJECTIVE: To quantify DOT among patients on anti-tuberculosis treatment and measure the association between proportion of DOT and TB treatment outcomes at a national level in Taiwan. DESIGN: We analyzed data prospectively collected on all new pulmonary TB cases reported to the national web-based registry between 1 January 2007 and 30 June 2008. We compared treatment outcomes and proportion of DOT in multivariable analyses. RESULTS: Among 11,528 patients initiating anti-tuberculosis treatment, the proportion of days during which an official DOT observer witnessed treatment was >60% for 5150 (45%) patients and ≤60% for 4601 (40%) patients, whereas for 1777 (15%) patients no days of DOT were recorded. Being older, male, having positive bacteriology results and a non-World Health Organization recommended treatment regimen at baseline were independently related to unsuccessful treatment outcomes and mortality. A dose-response effect was found between proportion of DOT and these outcomes. CONCLUSION: These findings highlight the importance of ensuring universal DOT in improving treatment outcomes among new pulmonary TB patients.