Direct Observation Pattern of DOTS (Directly Observed Treatment Short Course) by Alternate DOTS Providers for Patients Treated under RNTCP in a Tertiary Care Hospital

Direct Observation of Treatment Short course (DOTS) is the proven effective in controlling TB on a mass basis around the world. Direct observation is the central and key element for the success of the DOTS strategy. In India, Multi-purpose health workers play a major role in treatment observation; where they are not available, treatment observation is done by community volunteers including anganwadi workers, traditional dais, and community and religious leaders. The choice of DOTS provider should be based on access, patient preference and availability of the DOTS providers. This study was done to find the pattern of the direct observation component of the DOTS strategy by the professional and community DOTS providers and to find out their acceptance among the patients.

Material and Method

164 new sputum positive patients treated at rural and urban TB clinics of CMC Vellore from January 2001 to December 2004 were followed up during November 2005 along with their respective DOTS providers using separate structured questionnaires. The data entry and statistical analysis was done using SPSS data analysis package version 12.0. Chi2 test and t- test were used to test the significance of the data.

Result

Intensive Phase (IP) treatment was given alternate days by 94.5% of the community providers compared to 90.1% of professional providers. In Continuation Phase (CP) treatment, it was not expected by the RNTCP guidelines to give alternate days. But 34.2% of community providers had given on alternate days as in IP compared to only 4.4% of professional providers. The difference is statistically significant (p value <0.001). Patients observed by professional providers had to travel the mean distance of 0.91 Km compared to only 0.31 km with community providers (p value <0.001). The average time spent each time to get drugs from their providers in the professional arm is 27.42 minutes compared to only 14.86 minutes with community providers (p value <0.001). In the professional arm the main place was clinics/hospitals (90.1%) and in the community arm mainly either it was patients' house (452%) or providers' house (41.1%). In the professional arm, the patients are cumulated in the working hours of the professional providers and they are evenly distributed regarding time in the community arm.

Conclusion

The DOTS being provided at home with less consumption of time and lesser distance to travel are significantly different in the community arm of DOTS providers as compared to the professional DOTS providers.