TY - JOUR
T1 - The Baltimore City Health Department Program of directly observed therapy for tuberculosis
AU - Chaulk, P. C.
AU - Pope, D. S.
N1 - Funding Information:
When patients fail to comply with appropriate antituberculosis treatment, a Commissioner's Order for compulsory treatment may be issued. A Commissioner's Order advises the patient of the nature of his or her illness, the public interest in completing treatment, and the type and duration of required therapy. The patient is ordered to comply with treatment and warned that more coercive measures, including detention and incarceration, are available to enforce treatment. Detention orders are issued only after repeated efforts to initiate and continue therapy under Commissioner's Orders have failed. One alternative to compulsory detention, implemented in 1994, involves placing homeless patients or patients with unstable housing in a private motel for the duration of their therapy. This strategy has been supported with funding from the Maryland Department of Health and Mental Hygiene's Division of Tuberculosis Control.
Funding Information:
Further capacity building around the DOT Program is under way in Baltimore with a grant from the Robert Wood Johnson Foundation to design and implement a tuberculosis screening and prevention initiative within medically underserved communities of the city. This initiative involves the recruitment and training of community residents from within these same communities, who will provide nurse-supervised screening and isoniazid chemoprevention to eligible tuberculin-positive residents. This grant also supports the development of an electronic management information system to replace the manual tuberculosis record system that has existed for decades.
PY - 1997
Y1 - 1997
N2 - To address the vexing problem of treatment completion for tuberculosis patients, the Baltimore City Health Department (BCHD) in 1981 implemented a community outreach strategy employing directly observed therapy (DOT). By 1995, the incidence of tuberculosis in Baltimore had declined 61.7%. This BCHD program has reduced the need for patient incentives by providing nearly 90% of all DOT at either the patient's home, workplace or school; or drug treatment facility, city jail, or nursing home. Today, the proportion of all TB cases in Baltimore receiving DOT through the program approaches 90%, treatment completion rates exceed 90%, sputum-conversion rates among DOT- managed cases are nearly double the rates of privately treated cases, and drug resistant organisms remain rare (0.57% of all isolates, 1989-1993). This article describes the interworkings of this community-based program.
AB - To address the vexing problem of treatment completion for tuberculosis patients, the Baltimore City Health Department (BCHD) in 1981 implemented a community outreach strategy employing directly observed therapy (DOT). By 1995, the incidence of tuberculosis in Baltimore had declined 61.7%. This BCHD program has reduced the need for patient incentives by providing nearly 90% of all DOT at either the patient's home, workplace or school; or drug treatment facility, city jail, or nursing home. Today, the proportion of all TB cases in Baltimore receiving DOT through the program approaches 90%, treatment completion rates exceed 90%, sputum-conversion rates among DOT- managed cases are nearly double the rates of privately treated cases, and drug resistant organisms remain rare (0.57% of all isolates, 1989-1993). This article describes the interworkings of this community-based program.
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U2 - 10.1016/S0272-5231(05)70364-6
DO - 10.1016/S0272-5231(05)70364-6
M3 - Article
C2 - 9098619
AN - SCOPUS:0030978209
SN - 0272-5231
VL - 18
SP - 149
EP - 154
JO - Clinics in Chest Medicine
JF - Clinics in Chest Medicine
IS - 1
ER -