IMPACT OF THE CHANGE FROM AN INJECTABLE TO A FULLY ORAL REGIMEN ON PATIENT ADHERENCE TO AMBULATORY TUBERCULOSIS TREATMENT IN DAR-ES-SALAAM,TANZANIA

Setting: Out-patient tuberculosis clinics in Ilala and Kinondoni Distr icts, Dar es Salaam, Tanzania. Objective: To measure the impact on pat ient adherence to directly observed ambulatory tuberculosis treatment substituting an all-oral treatment regimen for a regimen containing st reptomycin. Methods: The expected and observed attendance of patients during the intensive phase of anti-tuberculosis treatment was measured daily at two out-patient clinics in Dar es Salaam. During the observa tion period, treatment was changed from a regimen containing streptomy cin to an all-oral regimen, and attendance proportions mere compared f or the three periods during which patients always, sometimes or never received streptomycin during the intensive phase of treatment. Results : In Kinondoni, an average of 98 patients was expected every day, in I lala 127. No significant difference was observed in attendance in Kino ndoni between periods when patients always (median attendance 95.9%) a nd never (median 95.7%) received streptomycin injections as part of th eir intensive phase treatment for tuberculosis. In Ilala, no differenc e was noted in attendance between the period in which patients receive d streptomycin for at least part of their treatment (median 91.3%) and the period when ethambutol had fully replaced streptomycin (median 91 .8%). Conclusions: In these two districts of Dar es Salaam, patient ad herence to a completely oral treatment regimen was indistinguishable f rom that to a streptomycin-containing regimen. Given the potential of iatrogenic transmission of HIV and the advantages in reduced staff tim e and drug costs, the results clearly justify the replacement of strep tomycin with ethambutol in Tanzania for new patients receiving an ambu latory rifampicin-containing regimen.