Chicago Tribune (04.04.13)
University of Texas Southwestern Medical Center researchers report that TB patients who are trusted to take medications on their own fare as well as those participating in directly observed therapy (DOT) programs. Dr. Tawanda Gumbo, associate professor of medicine and the study’s co-author, stated that it might be better to divert crucial resources used for DOT toward developing personalized systems for TB medications.
The research compared results from 10 studies of TB patients; 8,774 patients were on DOT, and 3,708 patients took medicines on their own. Each study tested the participants to see whether the patients still had TB, relapsed, or developed drug-resistant TB after treatment ended. Those taking TB medicine on their own did as well as DOT patients on all three criteria.
According to the World Health Organization (WHO), 1.4 million people died from TB in 2011, and WHO estimates 630,000 cases of multidrug-resistant TB (MDR TB) exist worldwide. To reduce the number of MDR TB cases, WHO recommends government-supported infrastructure to standardize diagnosis and doctor-monitored treatment of TB. Failing to take the full six-month course of TB medicines can result in development of MDR TB.
Dr. William Bishai, director of the KwaZulu-Natal Research Institute for Tuberculosis and HIV, stated that DOT works well in richer countries like the United States, where TB is “concentrated among a relatively small number of recalcitrant patients.” DOT’s cost-benefit might not be the same in resource-poor countries. However, Bishai doubted that setting up personalized TB treatments for underserved African patients would be possible. Bishai advocated community-based approaches that establish relationships between the care giver and patient.
The full report, “A Meta-Analysis of Self-Administered Versus Directly Observed Therapy Effect on Microbiologic Failure, Relapse, and Acquired Drug Resistance in Tuberculosis Patients,” was published online in the journal Clinical Infectious Diseases (2013: doi:10.1093/cid/cit167).