TUBERCULOSIS CONTROL IN SHINJUKU WARD, TOKYO Promoting the DOTS Program and Its Outcome

• Published in: Kekkaku Vol. 83; no. 9; pp. 611 - 620
• Main Authors: KAGURAOKA, Sumi, OHMORI, Masako, TAKAO, Yoshiko, YAMADA, Mari, MUROI, Masako, NAGAMINE, Michiko, FUKAZAWA, Keiji, NAGAI, Megumi, WADA, Masako, HOSHINO, Hitoshi, YOSHIYAMA, Takashi, MAEDA, Hideo, ISHIKAWA, Nobukatsu
• Format: Journal Article
• Language: Japanese
• Published: Japan JAPANESE SOCIETY FOR TUBERCULOSIS 01.09.2008
• Subjects: Communicable Disease Control - methods; Contact Tracing; Directly Observed Therapy - methods; DOTS; Foreigners; Homeless; Homeless Persons - statistics & numerical data; Humans; Patient Compliance - statistics & numerical data; Patient Dropouts - statistics & numerical data; Public health nurse; Recurrence; Risk; Shinjuku; Time Factors; Tokyo - epidemiology; Treatment outcome; Tuberculosis; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis - prevention & control; Tuberculosis - transmission; Tokyo
• ISSN: 0022-9776; 1884-2410
• DOI: 10.11400/kekkaku1923.83.611

[Objectives] The objectives were to report how to promote tuberculosis (TB) control including DOTS (Directly Observed Treatment, Short-course) programs, and to evaluate the results of TB control programs in Shinjuku Ward (Shinjuku-ku). [Setting and characteristics] Inhabitants and TB patients in Shinjuku Ward. Shinjuku Ward is located in the center of metropolitan Tokyo and has typical urban TB problems, such as high incidence rate and TB among foreigners and the homeless. The TB incidence rates in Shinjuku Ward decreased from 83.9 per 100, 000 population in 1999 to 42.5 per 100, 000population in 2006, however, the rates were still two times higher than the national average. Therefore, one of the important TB programs in Shinjuku has been to actively detect cases among high-risk groups such as foreigners and the homeless. [Methods] We observed the trend of case dete ction rates by health examination with chest X-ray among different highrisk groups, and compared the treatment outcomes before and after DOTS program execution. We also reviewed the changes of re-treatment rates and drug resistance rates. [Results] The case detection rates of T B by health examinations of foreign students at Japanese language schools decreased from 0.49% in 1996 to 0.13% in 2006 (p = 0.021). Although the case detection rates decreased, they were still about 26 times higher than those of Japanese students. While, the case detection rates among the homeless remained high with 4.7%, 3.3%, 4.5% and 3.6% in 1999-2002, respectively, since 2003, however, they had decreased and no TB cases were detected in 2005-2006. The DOTS program for homeless TB patients has been carried out since 2000 and that for the foreigners since 2003. The rates of defaulting during treatment before DOTS were very high among both homeless patients (21.4%) and foreigners (29.8%) in 1998-1999. However, after the introduction of DOTS program, those rates declined to 10.4% (p= 0.014) among the homeless and 7.8%(p = 0.002) among foreigners in 2002-2004. The propo rtion of newly notified patients with previous TB treatment and those with multi-drug resistant TB (MDR-TB) have also decreased after the introduction of DOTS programs. From 2000-2002 to 2003-2006, the re-treatment rates decre ased from 19.4% to 10.0% (p< 0.001) and MDR-TB rates decreased from 1.6% to 0.2% (p =0.042), respectively. [Discussion] The key points of TB co ntrol in Shinjuku Ward are to detect TB cases early especially among the highrisk groups, and to assist all TB patients to complete their treatment. In order to expand this strategy, besides promoting active case findings among high-risk groups, we have developed many types of DOTS programs, considering each patient's lifestyle and cooperating with school teachers at schools, pharmacists at pharmacies, home-care specialists at homes or facilities for the elderly, and so on. Among others, a major premise for the homeless and some other socially disadvantaged patients was to guarantee the provision of medicine and living by introducing social welfare services, before starting DOTS programs. This approach might have helped to reduce the defaulting rate, relapse rate and MDR-TB rate.