Directly observed therapy for tuberculosis in New York City: factors associated with refusal

Int J Tuberc Lung Dis. 2004 Apr;8(4):480-5.


Objectives: To describe patients who utilize hospital-based directly observed therapy (DOT) programs and to describe factors that influence refusal of DOT.

Methods: Retrospective analysis of patients diagnosed with tuberculosis through hospital admission in 1997 at 12 hospital sites with out-patient DOT programs. Data were obtained from hospital patient records and from the New York City Tuberculosis Case Registry.

Results: Of 443 patients diagnosed with tuberculosis in 1997 at the 12 hospital sites and available and/or eligible for DOT, 52 (12%) refused DOT. The two main reasons for DOT refusal were that the patients felt they could self-medicate (21%) and that their work schedule interfered with a DOT program (19%). White non-Hispanic race/ethnicity was associated with refusal of DOT (P = 0.001). Conversely, interview for DOT while in the hospital (P < 0.001) and enrollment in drug treatment were associated with acceptance of DOT (P = 0.05). The five hospitals with tuberculosis clinics on site had the lowest percentages (0-9%) of patients refusing DOT.

Conclusion: To increase patient acceptance of DOT, programs need flexible hours that accommodate patients in the workforce. Patient education should focus on the difficulty of completing tuberculosis treatment on a self-administered regimen and the importance of the support offered through DOT.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antitubercular Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Directly Observed Therapy / methods*
  • Female
  • Humans
  • Infant
  • Male
  • Middle Aged
  • New York City
  • Patient Admission
  • Retrospective Studies
  • Treatment Refusal
  • Tuberculosis / drug therapy*


  • Antitubercular Agents