Directly observed therapy for treating tuberculosis: Critical analysis of decentralization

Abstract

This article addresses decentralization of Directly Observed Therapy (DOT) for treating tuberculosis (TB) in a Brazilian city in the metropolitan region of Porto Alegre, state of Rio Grande do Sul. After implementing the strategy, treatment dropout rates decreased, but the city has not achieved the goal recommended by the World Health Organization (WHO). This qualitative research was conducted through interviews with primary care and health surveillance professionals. The results showed that decentralizing the procedure can mean adding another task to primary care and can base the understanding of a partial responsibility that is not coherent with this level of care. As a possibility to reduce dropout, we suggest a complete decentralization of primary health care and the constitution of a matrix support involving specialized professionals and the surveillance center.