DIRECTLY OBSERVED PREVENTIVE THERAPY - TURNING THE TIDE AGAINST TUBERCULOSIS

Objective: To compare compliance between directly observed preventive therapy and daily treatment for students with inactive (class II) tube rculosis. Design: Cohort analytic study and cost-effectiveness analysi s. Students found to be positive for purified protein derivative and h aving no abnormal chest x-ray films on mandated screening were advised to have prophylactic treatment with isoniazid. Treatment was either d irectly observed in the school health clinic or provided as daily ther apy by the Department of Health. Treatment completion, age, sex, ethni city, and recent immigration were compared between the 2 treatment gro ups. Setting: A school-based clinic at an inner-city New York, NY, hig h school. Results: In 1993, 864 students were screened. The positive p urified protein derivative rate was 19.3%. All 161 students had negati ve findings on chest x-ray films. Of the students, 105 (65.2%) were en rolled in the school-based clinic directly observed preventive therapy program, 22 were referred to the Department of Health for daily thera py, and 34 were excluded from the study before treatment. The 2 treatm ent groups did not differ in composition. Completion of therapy in the directly observed preventive therapy group (87.6%) was significantly greater than that in the daily therapy group (50%) (P=.001, chi(2)=11. 8) and that reported in the literature for programs other than directl y observed preventive therapy (30%-70%). Directly observed preventive therapy was administered by existing personnel without additional expe nditure. Conclusion: Directly observed preventive therapy is an effect ive strategy that should be used in the school clinic setting to incre ase compliance with prophylactic treatment for tuberculosis.