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Vol. 35. Issue 6.
Pages 267-274 (June 1999)
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Vol. 35. Issue 6.
Pages 267-274 (June 1999)
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Resultados e impacto epidemiológico de una unidad de tratamiento directamente observado de la tuberculosis
Results and epidemiological impact of directly observed therapy for tuberculosis
Visits
3714
J. Alcaide Megías
,**,1
Corresponding author
jalcaide@dsss.scs.es

Correspondencia: Dirección General de Salud Pública. Deparlamento de Sanidad y Seguridad Social. Pavelló Ave Maria. Travessera de les Corts. 131-159. 08028 Barcelona.
, J. Pascual Torramadé***, M.N. Altet Gómez*, J. Maldonado Díaz de Losada**,*, F. López Espinosa***, L.I. Salleras Sanmartí**
* Centro de Prevención y Control de la Tuberculosis Dr. Lluís Sayé
** Dirección General de Salud Pública. Departamento de Sanidad y Seguridad Social de la Generalitat de Catalunya
*** Unidad de Tratamiento Directamente Observado Serveis Clínics
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Objetivo

Analizar los resultados y el impacto epidemiológico sobre la tuberculosis de una unidad de tratamiento directamente observado (TDO) para enfermos no colaboradores.

Método

Estudio retrospectivo de las historias clínicas de los enfermos ingresados en la Unidad TDO de Cataluña desde su puesta en funcionamiento (marzo de 1993) hasta el 31 de agosto de 1998.

Resultados

En total son 470 enfermos: 102 corresponden a la primera época de la unidad, con insuficiente dotation. De los 368 ingresados en la segunda fase, desde el 1 de enero de 1996,176 (47,5%) se han curado, 27 (7,3%) han fallecido, 72 (19,5%) continúan en la unidad y 93 (25,2%) salieron de la unidad antes de concluir el tratamiento. De éstos, 25 se han curado, 31 han fallecido, 19 continuan el tratamiento directamente observado y 18 (el 4,9% del total de ingresados en la segunda fase) se han perdido. Por tanto, la conclusion final de los enfermos han sido: curados 201 (54,6%), fallecidos 58 (15,7%), mantienen el tratamiento directamente observado 91 (24,7%) y perdidos 18 (4,9%). La tasa de cumplimiento del tratamiento en esta fase ha sido del 91,8%. Posiblemente estos resultados hayan contribuido de manera importante a la reductión de la incidencia de tuberculosis en Cataluñia, casi el 30% desde 1992 a 1997, siendo muy importante el descenso de casos en el grupo de edad 20-44 años (33%) y, en consecuencia, también en los menores de 15 afios (55%) y, asimismo, se han reducido signifícativamente los casos de tuberculosis asociados a los principales factores de riesgo de enfermar (el 55% de descenso promedio, con el mínimo del 40,1% para los enfermos de sida y el máximo del 85,2% para los indigentes).

Conclusión

El tratamiento directamente observado se ha mostrado muy efectivo tanto para los pacientes como para la comunidad, aunque la tendencia epidemiológica actual se ha de atribuir tambien a otras muchas causas.

Key words:
Tuberculosis
Directly observed therapy
Epidemiology
Palabras clave:
Tuberculosis
Tratamiento directamente observado
Epidemiología
Objectives

To analyze the results and epidemiological impact on tuberculosis (TB) of directly observed therapy (DOT) for uncooperative patiens.

Method

Retrospective study of the case histories of patients admitted to the DOT unit in Catalonia (Spain) since its March 1993 inauguration until August 1998.

Results

Of a total of 470 patients, 102 were cared for during the unit's first phase, in which funding resources were insufficient. Of the 368 admitted during the second phase beginning January 1996; 176 (47.5%) were cured, 27 (7.3%) died, 72 (19.5%) were still at the unit and 93 (25.2%) left the unit before completing treatment. Of the last group, 25 were cured, 31 died 19 continued DOT and 18 (4.9% of all enrolled in the second phase) were lost to follow-up. Thus, the final outcome distribution for the patients was 201 (54.6%) cured, 58 (15.7% died, 91 (24,7%) still in DOT and 18 (4,9%) lost to follow-up. The compliance rate during the second phase was 91,8%. These results may have contributed significantly to the nearly 30% reduction in the incidence of TB in Catalonia between 1992 and 1997, a period which saw large decreases in the number of cases among 20-to-44-year-olds (33%) and consequently also among under-15-year-olds (55%). Likewise the number of cases of TB in high risk groups decreased, 55% on the average with a minimum decrease of 40,1% among AIDS patients and a maximum decrease of 85.2% among indigents.

Conclusion

DOT has proven highly effective both for patients and for the community, although many other factors must also be considered when accounting for the current epidemiological trend.

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