Directly observed therapy (DOT) is not the entire answer: An operational cohort analysis

B. Mangura, E. Napolitano, M. Passannante, M. Sarrel, R. McDonald, K. Galanowsky, L. Reichman

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


SETTING: New Jersey Medical School National Tuberculosis Center-Lattimore Clinic, a TB Clinic for an inner city population of Newark, New Jersey, USA. OBJECTIVE: Directly observed therapy (DOT) is the recommended standard of TB care. Recent reports suggest that DOT may not be any better than self-administered therapy (SAT). To quantify the impact of different levels of SAT, DOT, and active case management on outcomes of TB treatment at our location, we reviewed the outcomes of six TB patient-cohorts from Newark between 1 January 1994 and 31 December 1996. STUDY DESIGN: A retrospective cohort study of the outcomes of 343 tuberculosis patients treated during the years 1994-1996. The three treatment strategies were 1) self-administered with occasional selective directly observed therapy, 2) universal directly observed therapy alone (universal DOT), and 3) universal DOT with nurse case management (NCM). RESULTS: The first two cohorts who began treatment during the transition may have received more than one treatment strategy. However, universal DOT did not significantly improve the TB treatment completion rates of Cohort 2 over SAT therapy with selective DOT given to Cohort 1. Universal DOT with NCM, Cohorts 3, 4, 5, and 6, significantly increased the TB treatment completion rates by three to six times. A cohort-specific stepwise reduction in duration of treatment from a median of 11.6-7.5 months and an increase in completion rates from 57-81% resulted. The most desirable and optimal (shortest) duration of treatment completion coincided with the application of universal DOT combined with NCM.

Original languageEnglish (US)
Pages (from-to)654-661
Number of pages8
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number8
StatePublished - 2002

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases


  • Adherence
  • Case management
  • Directly observed therapy


Dive into the research topics of 'Directly observed therapy (DOT) is not the entire answer: An operational cohort analysis'. Together they form a unique fingerprint.

Cite this