A novel approach to directly observed therapy for tuberculosis in an HIV-endemic area

Objectives. This study evaluated a novel approach to the delivery of direct ly observed therapy (DOT) for tuberculosis in Haiti. Methods. A total of 194 patients (152 HIV seropositive, 42 HIV seronegative ) received daily unsupervised triple-drug therapy for 4 to 8 weeks, followe d by twice-weekly 2-drug therapy for the remainder of the 6-month period. D OT was deferred until initiation of the twice-weekly phase. Results. A total of 169 of 194 patients (87.1%) completed the 6-month cours e. The program of deferred DOT had an effectiveness of 85%. Overall cost wa s reduced by approximately 40%. Conclusions. Flexible approaches to DOT, integrating behavioral knowledge, cost considerations, and practicality may improve completion rates and prog ram effectiveness.