Treatment of tuberculosis in a rural area of Haiti: directly observed and non-observed regimens. The experience of Hopital Albert Schweitzer

SETTING : Artibonite Valley, a rural area in Haiti. OBJECTIVE: TO evaluate a tuberculosis control program in rural Haiti and to compare two strategies for treatment implemented in two areas that were no t chosen at random: treatment delivered at the patients' homes observed by former tuberculosis patients (DOT), and non observed treatment (non-DOT). DESIGN : Retrospective analysis of the clinical records of adult patients d iagnosed with tuberculosis at Hopital Albert Schweitzer in Deschapelles, Ha iti, during 1994-1995. RESULTS:There were 143 patients in the non-DOT group and 138 patients in th e DOT group. The results of treatment were significantly different: in the non-DOT group 29% defaulted, 12% died and 58% had a successful outcome; in the DOT group 7% defaulted (P < 0.01), 4% died (P = 0.01) and 87% had a suc cessful outcome (P < 0.01). These differences are also significant when con sidering only human immunodeficiency virus (HIV) infected patients (default ed P < 0.01; died P = 0.09; successful outcome P < 0.01). CONCLUSION: Delivering treatment in patients' homes with direct observation by former tuberculosis patients can achieve good results, even in an area of extreme poverty and high rates of HIV infection. In this population the number of patients who are able to complete their treatment without observe d administration is far from optimal.