The influence of program acceptability on the effectiveness of public health policy: A study of directly observed therapy for tuberculosis

Objectives. This study examined how patient acceptability influences the effectiveness of directly observed therapy for tuberculosis. Methods. Decision and sensitivity analysis were used assessing influences. Results. If mandatory directly observed therapy discourages 6% of initial tuberculosis patients (range 4% to 10%) from seeking care, then such therapy will be less effective than self-administered therapy. Directly observed therapy is more effective than repeated self-administered therapy for patients failing to complete initial treatment unless 32% - (range 27% to 38%) - of patients avoid seeking care. Conclusions. Patient acceptability must be taken into consideration before selecting public health strategies.