OBJECTIVETo evaluate the effectiveness of directly observed treatment (DOT) implementation in tuberculosis (TB) control in China.

METHODSSystematic literature review was carried out for published and unpublished articles regarding DOT, and meta analysis was used to compile results from selected papers. Also, sensitive analysis was carried out to explore the potential factors influencing the effectiveness of DOT.

RESULTSTwo hundred and four articles were identified from China National Knowledge Infrastructure, Wanfang and Medline databases during 1994 - 2004 in which 120 articles were eligible according to our selection criteria. (1) Regarding TB case management: TB patients managed under DOT was compared to cases managed under the whole course treatment management (WCM). The combined RD of cure rate was 0.14 (95% CI: 0.06 - 0.22) and the two case management methods were significantly different (P < 0.00001). Data from stratified analysis showed that strict implementation of WMC had similar effectiveness with DOT (P = 0.06), and with RD 0.02 (95% CI: 0.00 - 0.03). However, the cure rate of DOT management was significantly better than that under un-strict WCM management (P < 0.05) with RD 0.16 (95% CI: 0.07 - 0.24). The cure rate of DOT was significantly better than those patients under self-administration (RD was 0.24 with 95% CI: 0.10 - 0.38 and P = 0.002). (2) Chemotherapeutics: when short-course and long course-treatments were compared, the combined RD became 0.04 (95% CI: 0.01 - 0.07) and P = 0.003.

CONCLUSIONSIf the implementation was under strict management, the different models of patient management showed similar adherence rates. However, the effect of adherence would depend on the regimen, pattern of intake of the drugs and the methods of supervision being used.