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

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Abstract
This study examined how patient acceptability influences the effectiveness of directly observed therapy for tuberculosis. Decision and sensitivity analyses were used in assessing influences. 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. Patient acceptability must be taken into consideration before selecting public health strategies.