COMPREHENSIVE TUBERCULOSIS-CONTROL FOR PATIENTS AT HIGH-RISK FOR NONCOMPLIANCE

The current tuberculosis epidemic in the United States is marked, in m any areas, by high rates of noncompliance with antituberculous regimen s. In response to this, a comprehensive program of medical, nursing, s ocial services, and supervised therapy was developed at Bellevue Hospi tal. Most patients were referred to the on-site directly observed ther apy program (DOT) located in the hospital. Patients on DOT received da ily or twice weekly therapy, and were given incentives to enhance comp liance. Outreach was used to track patients who missed appointments. F rom November 1992 through July 1993, 113 patients were referred. HIV i nfection, homelessness, illicit drug use, and alcoholism were common. Follow-up revealed that 11 patients were noncompliant and completely l ost to follow-up; of the remaining 102, 99% achieved bacteriologic cur e. Of the 102 patients who received therapy, 74 attended the Bellevue DOT clinic, 16 attended other DOT programs in the city or received med ication at home, and three died of HIV-related, nontuberculous illness . Nine patients were self-medicated and judged treatment successes. We conclude that a comprehensive hospital-based tuberculosis control pro gram is capable of achieving a high degree of success, even in a popul ation at high risk for noncompliance.