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Direct observation of tuberculosis treatment did not promote higher cure rates than self administered treatment

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 QUESTION: In Pakistani patients with tuberculosis, what is the effectiveness of the directly observed treatment, short-course (DOTS) strategy by a health worker or family member?


8 month randomised {allocation concealed*}, blinded (clinicians and outcome assessors),* controlled trial.


3 tuberculosis treatment centres in Pakistan.


497 patients who were ≥15 years of age (42% were 15 to 24 y, 22% were 25 to 34 y; 51% men) and were newly diagnosed with sputum-positive pulmonary tuberculosis, had not previously received tuberculosis treatment, and lived in the catchment area. Follow up was complete.


Patients were allocated to 1 of 3 treatments: self administered treatment, in which patients received tuberculosis drugs every 2 weeks from the closest health facility (n=162); health worker DOTS, involving a 2 month intensive phase during which a health …

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  • Source of funding: Department for International Development, UK.

  • For correspondence: Dr J D Walley, Nuffield Institute for Health, University of Leeds, Leeds LS2 9PL, England, UK. Fax +44 (0)113 246 0899.

  • * See glossary.

  • Information provided by author.