Fig. 1 Trends of TB incidence rates for all forms and smear-positive pulmonary TB in Kawasaki City and Japan. Incidence=newly notified cases of all fo

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1 Kekkaku Vol. 79, No. 1: 17-24, (Received 21 Aug. 2003/Accepted 18 Nov. 2003)

2 Fig. 1 Trends of TB incidence rates for all forms and smear-positive pulmonary TB in Kawasaki City and Japan. Incidence=newly notified cases of all forms of TB in (new criteria in ). Smear-positive incidence=cases were based on all forms of TB in , pulmonary TB in , and sputum smearpositive pulmonary TB (new criteria) in Fig. 2 TB incidence rates for all forms by ward in Kawasaki City and surrounding cities, TB incidence rates were calculated using summation of newly notified TB cases and population for 5 years. *: Location of the municipal Ida Hospital

3 TB Control in Kawasaki City/Y.Tada et al. Table Results of mass screening for TB performed for homeless persons, by year, Kawasaki-ward in Kawasaki City,

4

5 TB Control in Kawasaki City/Y.Tada et al. 21

6 Fig. 3 Trends of TB incidence rates for all forms and sputum smear-p0sitive pulmonary TB by ward in Kawasaki City,

7 TB Control in Kawasaki City/Y.Tada et al. Fig. 4 Treatment outcomes for new sputum smear-positive pulmonary TB cases registered in The size of cohort eligible for evaluation in each year from 1997 to 2001 was 150, 151, 140, 129 and 149, respectively. The number of cases who could be evaluated in fact in each cohort was 55 (36.7%), 142 (94.0%), 124 (88.6%), 127 (98.4%) and 149 (100%). The DOT program has been implemented since 2000.

8 13) Fujiwara PI : A decade of successful tuberculosis control in New York City-the role of DOT vs DOTS- Œ Šj ; 77 : ) Fujiwara PI, Larkin C, Frieden TR : Directly observed therapy in New York City, history, implementation, results and challenges. Clincs in Chest Medicine ; 18 : ) Frieden TR, Fujiwara PI, Washko RM, et al. : Tuberculosis in New York City turning the tide. N Eng J Med ; 333 : Field Activities TUBERCULOSIS CONTROL IN KAWASAKI CITY Promoting the DOT Program Yuki TADA, 2Masako OHMORI, 2Kunihiko ITO, and 3Michiko FUJIU Abstract Kawasaki City initiated the DOT (Directly Observed Therapy) program in 2000 to improve tuberculosis (TB) control in the homeless persons and individuals living in temporary subsidized housing. The program was implemented as an additional program to the city's control policy of mass TB screenings for these groups. The DOT program was implemented through participation of numerous agencies sharing common goals. Through coordination and cooperation, a strategy suitable for the regional level was developed. Sectors involved were not only the TB control staff within the public health centers but also the entire public health centers, the welfare administrative division, the city's TB task force and homeless task force, and regional medical institutions. With the implementation of the DOT program, proper medical treatment, improved patient care, and various other measures were performed, and this led to the strengthening of TB control not only in designated DOT-implemented areas but also in the entire city. As a result, the treatment outcomes improved, and incidence rate of TB began to decrease. Key words : Tuberculosis control, Urban tuberculosis, Homeless persons, Assured treatment, DOT (directly observed therapy) Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 2Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3Health Welfare Center, Kawasaki-ku, Kawasaki City Correspondence to : Yuki Tada, Infectious Disease Surveillance Center, National Institute of Infectious Diseases,1-23-1, Toyama, Shinjuku-ku, Tokyo Japan. (

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