High cure rates in smear-positive tuberculosis patients using ambulatory treatment with once-weekly supervision during the intensive phase in Sulawesi, Republic of Indonesia

SETTING: The four provinces of Sulawesi, Republic of Indonesia. OBJECTIVE: Treatment of smear-positive pulmonary tuberculosis patients usin g ambulatory treatment with supervision once weekly during the intensive ph ase and once fortnightly during the continuation phase. DESIGN: Pilot projects with gradual expansion of activities according to de fined quantitative criteria. RESULTS: During the period January 1993-December 1997, 11879 new smear-posi tive and 320 smear-positive previously treated patients, of whom 259 were r elapses, were placed on short-course chemotherapy. At the end of the intens ive phase, 87.5% of new patients and 80.0% of retreatment patients had beco me sputum smear-negative. During the period January 1993-December 1996, of 7251 new smear-positive patients placed on treatment 85.2% were cured and a n additional 7.9% had completed treatment, giving a total success rate of 9 3.1%. For 239 patients placed on retreatment the total success rate was 86. 6%. CONCLUSION: The treatment results show that the policy introduced in Sulawe si is effective. In two provinces priority will now be given to increasing case detection, while in the other two provinces the emphasis will be on re aching full coverage. The reasons for the success of the projects are discu ssed, as are the prerequisites for introducing the policy in other areas.