SHANDONG - CHINA

TB care quality improvement study in Shandong

In China patients are told to attend alternate days for Direct Observation of Treatment (DOT) by their village doctor, however there is evidence that most do not take their self-administered treatment. Furthermore, TB is a stigmatised condition and patients are reluctant to attend for treatment observation by the village doctor (a private community health practitioner). In contrast, support and direct observation by family members incurs little inconvenience and negligible costs to the patient since patients, once well enough, are not constrained in continuing their normal work and without the potential for stigma.

This study aimed to evaluate the effectiveness of the three approaches of TB management. These are family member support and direct observation of treatment, family member support but without DOT, and the current village doctor DOT (self administration de facto). A cohort study comparing three countries implementing the alternative treatment supervision strategies was conducted. The study was carried out in the context of a review of the effectiveness of the current policy of requiring all patients to attend the village doctor for observed treatment. The study findings are expected to contribute to evidence-based decisions on the future control policy in China and worldwide.