Dots evaluation in primary health care in Rio de Janeiro

Introduction. Tuberculosis (TB) control continues a goal to be achieved in Brazil. In the last ten years the brazilian Ministry of Health adopted a clear decision to decentralize tuberculosis management, involving the Strategy of Family Health.  The objective of this study was to evaluate the DOTS treatment in primary health setting in Rio de Janeiro, Brazil.
Methods. A cohort of 350 pulmonary TB patients treated for six months using DOTS was followed in a poor area in the periphery of Rio de Janeiro, the second largest brazilian city, in the 2005-2006 period. All patients were followed in the primary care setting. Two strategies have been adopted. The first one used community health workers, who go to the houses of patients. The second DOTS strategy was implemented with health professionals, and patients go to the health unit, to receive treatment.
Results. Results showed an overall cure rate of 67%, with a total drop-out of treatment of 19%, and a death rate of 5%. Remaining 9% were transfered to other settings. There was no significant difference between the two DOTS strategies adopted so far. On going analysis of 2007 data showed a further reduction in dropout rate (<15%).
Discussion. Drop-out of treatment is still a serious problem in TB control. Previous data  from the areas studied showed a drop-out between 20-30%. DOTS adopted in a primaty health setting points to a clear decline in drop-out of treatment. The results presented also points to the favorable use of community health workers in delivering DOTS.
Conclusion.  DOTS is an important strategy to control TB in a primary health setting, in Rio de Janeiro, Brazil. Community health workers, who visits patients at home, seem to be good allies to achieve as low drop-out of treatment as possible. Efforts for decentralization should be continued and enhanced.