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Consensus Statement of the Public Health Tuberculosis Guidelines Panel

C. Patrick Chaulk, MD, MPH; Vahe A. Kazandjian, PhD, MPH; for the Public Health Tuberculosis Guidelines Panel

JAMA. 1998;279:943-948.

Objective.— To evaluate evidence on the relative effectiveness of directly observed therapy in achieving treatment completion for pulmonary tuberculosis.

Participants.— A panel of 11 practitioners representing the public health, behavioral, and clinical management of tuberculosis was convened by the Council on Linkages Between Academia and Public Health Practice in 1995 to develop public health guidelines for tuberculosis treatment completion.

Evidence.— English-language articles identified through MEDLINE (1966 to August 1, 1996) with original data on directly observed therapy, supervised therapy, compliance, treatment completion, case management, and treatment adherence for tuberculosis.

Consensus Process.— Each eligible article underwent structured review by at least 2 panel members for study design, sample size, evaluation methods, and treatment completion as the primary outcome. The full panel was convened twice, with intercurrent small group meetings, conference calls, and summary workshop to review findings. Recommendations made through this process were drafted by the panel chair and circulated twice for additional panel comments.

Conclusions.— Treatment completion rates for pulmonary tuberculosis are most likely to exceed 90%, as recommended by the Centers for Disease Control and Prevention, when treatment is based on a patient-centered approach using directly observed therapy with multiple enablers and enhancers. Other less intensive interventions, including nonsupervised strategies and modified approaches to directly observed therapy, are unlikely to achieve this recommended treatment completion goal. Directly observed therapy also appears to be cost-effective compared with self-administered therapy, although data on cost-effectiveness are limited.

From the Annie E. Casey Foundation (Dr Chaulk), the Johns Hopkins Schools of Hygiene and Public Health (Drs Chaulk and Kazandjian) and Medicine (Dr Chaulk), and the Center for Performance Sciences, Inc (Dr Kazandjian), Baltimore, Md.

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