Direct observation and adherence to tuberculosis treatment in Chongqing, China: a descriptive study

Hu, D., Liu, Xiaoyun, Chen, J., Wang, Y., Wang, T., Zeng, W., Smith, Helen ORCID: https://orcid.org/0000-0002-6252-3793 and Garner, Paul ORCID: https://orcid.org/0000-0002-0607-6941 (2008) 'Direct observation and adherence to tuberculosis treatment in Chongqing, China: a descriptive study'. Health Policy and Planning, Vol 23, Issue 1, pp. 43-55.

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Abstract

Introduction China has an estimated 5 million people with tuberculosis (TB). Official policy is that treatment of all patients is directly observed by health workers; completion rates are reported to be in excess of 90, and drugs should be supplied for free. However, some research suggests there is a gap between the official policies and practice.
Methods Survey of TB patients in four counties of one municipality; record assessment at one TB centre; patient and village doctor in-depth interviews.
Results Sixteen per cent (64/401) reported being directly observed every time they took treatment; less than 5 of TB patients (17/401) were observed by health staff. Overall, 12.5 (50/401) reported they had not taken any TB drugs in the previous week, but this varied between the four counties (range 6.2 to 21.7). We used survival analysis with medical records at one centre: 74.1 of new patients collected their drugs for their sixth month of treatment, and 50.3 attended the final visit at 6 months. Qualitative research indicated direct observation is neither well understood nor thought to be necessary, and that patients reported being charged expensive fees for ancillary treatments, such as liver protection drugs.
Conclusion In China, direct observation is not well implemented and may not be a feasible policy option. Official completion rates are higher than we found in this study. The concept of free treatment has become blurred, with charges for additional tests and drugs, especially liver protection drugs. The government is already actively tackling these issues, and involvement of managers and others in this process will be helpful.

Item Type:	Article
Additional Information:	Please acknowledge the Journal Health Policy and Planning and Oxford University Press as the original place of publication. Citation: Daiyu Hu, Xiaoyun Liu, Jing Chen, Yang Wang, Tao Want, Wei Zeng, Helen Smith, and Paul Garner Direct observation and adherence to tuberculosis treatment in Chongquing, China: a descriptive study Health Policy Plan. 2008 23: 43-55; doi: 10.1093/heapol/czm038
Subjects:	WB Practice of Medicine > Medical Climatology > WB 710 Diseases of geographic areas WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
Faculty: Department:	Groups (2002 - 2012) > International Health Group
Digital Object Identifer (DOI):	https://doi.org/10.1093/heapol/czm038
Depositing User:	Philomena Hinds
Date Deposited:	16 Jul 2010 11:39
Last Modified:	17 Jul 2020 10:58
URI:	https://archive.lstmed.ac.uk/id/eprint/812

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