Fostering Directly Observed Treatment in Tuberculosis: A Program Manager’s Perspective

Authors

Department of Community Medicine, Shri Sathya Sai Medical College & Research Institute, Kancheepuram, India

Abstract

Global Tuberculosis (TB) report (2013) has revealed that an estimated 8.6 million people developed TB of which, India accounts for almost 26% of the cases. These estimates clearly suggest that the country’s efforts to achieve Millennium Development Goal 6 by 2015 have not delivered the desired output. In India, the TB prevention and control activities are supervised and implemented under the Revised National TB Control Program (RNTCP), which recognizes that implementation of a good quality Directly Observed Treatment with Short course chemotherapy (DOTS) is the first priority for TB control. Directly Observed Treatment (DOT) is the key element in DOTS strategy, in which a DOT provider insures and supports the patients in consuming their drugs throughout the course of treatment. In order to meet the country’s vision to achieve universal access of TB care, the RNTCP has launched a “treatment adherence scheme” (public-private partnership scheme). Further, an evidence-based integrated strategy should be formulated for addressing the identified barriers which advocates universal administration of DOT. To conclude, DOT in RNTCP insures long-term adherence to the treatment, with right drugs in right doses, at right intervals and thus plays an indispensable role in improving the outcome indicators of the program and the quality of life in patients.

Keywords


  1. World  Health  Organization. Global Tuberculosis Control Report 2013.  Geneva:  WHO;  2013.
  2. TBC India. Managing the RNTCP in your area - A training course (Modules  1-4)  [internet]. [cited  2013 Sep]. Available  from: http://tbcindia.nic.in/documents.html
  3. TBC  India.  Guidelines  for  PMDT  in  India,  2012  [internet].  [cited 2013  Sep].  Available  from:  http://tbcindia.nic.in/documents.html
  4. Pasipanodya JG, Gumbo T. A meta-analysis of self-administered vs  directly  observed  therapy  effect  on  microbiologic  failure, relapse, and acquired drug resistance in tuberculosis patients. Clin Infect Dis 2013; 57: 21–31. doi: 10.1093/cid/cit167
  5. Seaworth BJ, Armitige LY, Griffith DE. First do no harm--adverse events, drug intolerance, and hepatotoxicity: how can we not justify directly observed therapy for treating tuberculosis? Clin Infect Dis 2013; 57: 1063–4. doi: 10.1093/cid/cit432
  6. Chung  WS,  Li  CR.  Can  DOTS  improve  quality  of  life  among patients with pulmonary tuberculosis? Int J Tuberc Lung Dis 2013; 17:  425–6. doi: http://dx.doi.org/10.5588/ijtld.12.0701
  7. Mkopi A, Range N, Lwilla F, Egwaga S, Schulze A, Geubbels E, et al. Adherence to tuberculosis therapy among patients receiving home-based directly observed treatment: evidence from the United Republic of Tanzania. PLoS One 2012; 7: e51828. doi: 10.1371/journal.pone.0051828
  8. Ministry of Health and Family Welfare. National Family Health Survey (NFHS-3); 2005-06 [internet]. [cited 2013 Sep]. Available from: http://www.measuredhs.com/pubs/pdf/SR128/SR128.pdf
  9. TBC India. Managing the RNTCP in your area - A training course (Modules  5-9)  [internet]. [cited  2013 Sep]. Available  from: http://tbcindia.nic.in/documents.html
  10. TBC  India.  RNTCP Annual  Report  2011  [internet].  [cited   2013 Dec].  Available  from:  http://tbcindia.nic.in/documents.html
  11. Sharma SK, Mohan A, Chauhan LS, Narain JP, Kumar P, Behera D, et al. Contribution of medical colleges to tuberculosis control in India under the Revised National Tuberculosis Control Programme (RNTCP): lessons learnt & challenges ahead. Indian J Med Res 2013; 137: 283–94.
  12. Gassanov MA, Feldman LJ, Sebastian A, Kraguljac MJ, Rea E, Yaffe B. The use of videophone for directly observed therapy for the treatment of tuberculosis. Can J Public Health 2013; 104: e272.
  • Receive Date: 25 November 2013
  • Revise Date: 05 December 2013
  • Accept Date: 01 December 2013
  • First Publish Date: 01 January 2014