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Health Policy and Planning 2008 23(1):43-55; doi:10.1093/heapol/czm038
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Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2008; all rights reserved.
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

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

Daiyu Hu1, Xiaoyun Liu2,4,*, Jing Chen3, Yang Wang3, Tao Wang2, Wei Zeng3, Helen Smith4 and Paul Garner4

1Chongqing Institute of TB Prevention and Treatment, Jiulongpo district, Chongqing, China.
2School of Public Health, Fudan University, Shanghai, China.
3School of Public Health, Chongqing Medical University, Chongqing, China.
4Liverpool School of Tropical Medicine, Liverpool, UK.

* Corresponding author. International Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. Tel: +44 151 705 3254. Fax: +44 151 705 3364. E-mail: xliu{at}liv.ac.uk

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.

Key Words: Tuberculosis, DOT, compliance, China

Accepted for publication 13 August 2007.


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