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Yakubu Sani Ibn,Giwa Abdulganiyu,Momodu Halima,Muazu Jamilu
International Research Journal of Pharmacy , 2012,
Abstract: The major challenges of treating patients with pulmonary tuberculosis have been those of compliance and increasing incidence of multi-drug resistance. The use of directly observed treatment-short course (DOTS) has been widely reported to improve treatment success in settings where this treatment strategy recommended by the World Health Organization was implemented. Therefore the study was to determine the success rate of implementing DOTS strategy to patients with pulmonary tuberculosis in the University of Maiduguri Teaching Hospital, Nigeria. A survey of the records of treatment of patients with pulmonary tuberculosis using the DOTS strategy over a three-year period from January, 2007 to December, 2009 in the Teaching Hospital was retrospectively carried out. Treatment success (Cure and treatment completion) was recorded in 1434 (85.5 %) patients, while 203 (12.1%) patients either defaulted or were lost to follow up. Forty-one (2.4 %) patients died in the course of treatment. The DOTS strategy in the Teaching Hospital was effective since the success rate was close to the projected value for the whole country.
A Study of Treatment Compliance in Directly Observed Therapy for Tuberculosis  [cached]
Pandit N,Choudhary SK
Indian Journal of Community Medicine , 2006,
Time of default in tuberculosis patients on directly observed treatment
Pardeshi Geeta
Journal of Global Infectious Diseases , 2010,
Abstract: Background: Default remains an important challenge for the Revised National Tuberculosis Control Programme, which has achieved improved cure rates. Objectives: This study describes the pattern of time of default in patients on DOTS. Settings and Design: Tuberculosis Unit in District Tuberculosis Centre, Yavatmal, India; Retrospective cohort study. Materials and Methods: This analysis was done among the cohort of patients of registered at the Tuberculosis Unit during the year 2004. The time of default was assessed from the tuberculosis register. The sputum smear conversion and treatment outcome were also assessed. Statistical Analysis: Kaplan-Meier plots and log rank tests. Results: Overall, the default rate amongst the 716 patients registered at the Tuberculosis Unit was 10.33%. There was a significant difference in the default rate over time between the three DOTS categories (log rank statistic= 15.49, P=0.0004). Amongst the 331 smear-positive patients, the cumulative default rates at the end of intensive phase were 4% and 16%; while by end of treatment period, the default rates were 6% and 31% in category I and category II, respectively. A majority of the smear-positive patients in category II belonged to the group ′treatment after default′ (56/95), and 30% of them defaulted during re-treatment. The sputum smear conversion rate at the end of intensive phase was 84%. Amongst 36 patients without smear conversion at the end of intensive phase, 55% had treatment failure. Conclusions: Patients defaulting in intensive phase of treatment and without smear conversion at the end of intensive phase should be retrieved on a priority basis. Default constitutes not only a major reason for patients needing re-treatment but also a risk for repeated default.
Tuberculosis: limitations and strengths of Directly Observed Treatment Short-Course
Queiroz, Elisangela Martins de;De-La-Torre-Ugarte-Guanilo, Mónica Cecilia;Ferreira, Kuitéria Ribeiro;Bertolozzi, Maria Rita;
Revista Latino-Americana de Enfermagem , 2012, DOI: 10.1590/S0104-11692012000200021
Abstract: this study analyzed the limitations and strengths of the directly observed treatment short-course (dots) for tuberculosis from the perspective of patients and healthcare providers in a technical health supervision unit in the city of s?o paulo, sp, brazil. four patients and 17 healthcare providers from nine primary care units were interviewed from april to june 2006, after signing free and informed consent forms. the reports were decoded according to the speech analysis technique. the theory of the social determination of the health-disease process was adopted as the theoretical framework. the strengths were: establishment of bonds between healthcare providers and patients and the introduction of incentives, which promotes treatment adherence. limitations included: restricted involvement of dots' healthcare providers and reconciling patients' working hours with supervision. treatment adherence goes beyond the biological sphere and healthcare providers should acknowledge patients' needs that go beyond the supervision of medication taken.
The role of the Brezovik hospital in education of health professionals on the implementation of directly observed treatment strategy
Glu?ica Dobrislav,?uri? Branislav
Medicinski Pregled , 2007, DOI: 10.2298/mpns0710453g
Abstract: Introduction. In 2003, the International Union Against Tuberculosis and Lung Disease (IUATLD) reported that tuberculosis is increasing globally more than ever in the history of mankind. Thus, tuberculosis is one of the major health problems of the twenty-first century. Implementation of DOTS strategy. Directly Observed Therapy Short-Course (DOTS) is the WHO's strategy for tuberculosis control. All HBCs (High-burden Countries) have a strategic plan for DOTS expansion for the next five years. The DOTS strategy is included in the country’s basic package of health-care services. With the introduction of the DOTS strategy in late 1990s, the surveillance was improved, although the 2003 estimate of 53% DOTS coverage is probably optimistic. The role of the Brezovik Hospital in the National TB Program. The Special Hospital for lung diseases Brezovik is the main regional hospital for tuberculosis treatment in Montenegro, and the place where the DOTS strategy is being implemented. Conclusion. The Special Hospital for lung diseases Brezovik plays a very important role in education of health care professionals. .
An Ethnographic Study on the Factors Affecting Adherence to Directly Observed Treatment Short-Course in Typical Indian Settings  [PDF]
Neeraj Talukdar, Avinandan Basu, Ravi Mokashi Punekar
Journal of Tuberculosis Research (JTR) , 2015, DOI: 10.4236/jtr.2015.31003
Abstract: Efficient management of chronic illness remains a common clinical problem. Non-adherence to a prescribed medical regimen remains a tremendous barrier to the effective medical management of chronic diseases and is considered one of the most serious problems that the medical world faces in the present. Tuberculosis is one such chronic disease which has been a prevalent problem in most of the developing nations, including India. In this paper, we describe an ethnographic study conducted in the state of Assam, with the objective of deciphering the multiple factors that are associated with the failure of the treatment regimen of Tuberculosis, viz. the DOTS (Directly Observed Treatment Short course) programme under RNTCP (Revised National Tuberculosis Control Programme).
Preliminary report of directly observed treatment, short course in tuberculous meningitis
Iype Thomas,Chacko Sinchu,Raghavan Sivadasan,Mathew Robert
Annals of Indian Academy of Neurology , 2010,
Abstract: Background: Diagnosis of tuberculous meningitis (TBM) is a challenge because of the manifold clinical presentation, and diagnosis is often delayed. Objectives: We wanted to share our experience of directly observed treatment short course (DOTS) in TBM. We did a retrospective analysis to look at the presentation, management and outcome of TBM patients from November 2006 to April 2008. Materials and Methods: TBM was diagnosed based on clinical criteria. We excluded patients with HIV. Results: We had 11 patients on DOTS regime. One died following hepatitis and another patient died of unrelated gastroenteritis. The only patient on daily regime died. Our patients generally presented late, at a median duration 20 days from onset of symptoms, and 50% had stage 3 disease at presentation. The median delay in diagnosis was 4.5 days. Discussion: We found DOTS to be effective in TBM but not without side effects.
Survival analysis and risk factors for death in tuberculosis patients on directly observed treatment-short course  [cached]
Pardeshi Geeta
Indian Journal of Medical Sciences , 2009,
Abstract: Background : Tuberculosis is a disease with a high case fatality of 4.65%. Objectives : To describe the survival pattern of patients on Directly Observed Treatment-Short course (DOTS) according to categories, age and sex of patients. Settings : Tuberculosis unit (TU) at District Tuberculosis Centre (DTC), Yavatmal, India Design : Retrospective cohort study. Materails and Methods : Data of patients registered for DOTS in the year 2004 were collected from the tuberculosis register. Statistical Analysis : Kaplan Meier plots and log rank tests to assess the survival pattern. Cox proportional hazards model for multivariate analysis. Results : A total of 716 patients were registered at the TU. The survival rates by the end of the intensive phase were 96%, 93% and 99% in categories I, II and III of DOTS, respectively. The cumulative survival rates were 93%, 88% and 96% in the three DOTS categories, respectively. There was a significant difference in the survival curves amongst the three DOTS categories (log rank statistic= 7.26, d.f..= 2, P=0 0.02) and amongst the different age groups [log rank statistic= 8.78, d.f.= 3, P= 0.012). There was no difference in the survival curves of male and female patients (log rank statistic= 0.05, d.f.= 1, P= 0.80) and according to type of disease (log rank statistic= 5.63, d.f.= 2, P= 0.05). On Cox proportional hazard analysis, age groups of 40 to 60 years [adjusted hazard ratio= 7.81 (1.002-60.87)] and above 60 years [adjusted hazard ratio= 21.54 (2.57-180.32)] were identified as significant risk factors for death. Conclusions : Age above 40 years is a significant risk factor for death in patients of tuberculosis. There was a significant difference in survival curves of the three DOTS categories and age groups.
Directly observed treatment, short-course strategy and multidrug-resistant tuberculosis: are any modifications required?
Bastian,I.; Rigouts,L.; Van Deun,A.; Portaels,F.;
Bulletin of the World Health Organization , 2000, DOI: 10.1590/S0042-96862000000200014
Abstract: multidrug-resistant tuberculosis (mdrtb) should be defined as tuberculosis with resistance to at least isoniazid and rifampicin because these drugs are the cornerstone of short-course chemotherapy, and combined isoniazid and rifampicin resistance requires prolonged treatment with second-line agents. short-course chemotherapy is a key ingredient in the tuberculosis control strategy known as directly observed treatment, short-course (dots). for populations in which multidrug-resistant tuberculosis is endemic, the outcome of the standard short-course chemotherapy regimen remains uncertain. unacceptable failure rates have been reported and resistance to additional agents may be induced. as a consequence there have been calls for well-functioning dots programmes to provide additional services in areas with high rates of multidrug-resistant tuberculosis. these ‘‘dots-plus for mdrtb programmes’’ may need to modify all five elements of the dots strategy: the treatment may need to be individualized rather than standardized; laboratory services may need to provide facilities for on-site culture and antibiotic susceptibility testing; reliable supplies of a wide range of expensive second-line agents would have to be supplied; operational studies would be required to determine the indications for and format of the expanded programmes; financial and technical support from international organizations and western governments would be needed in addition to that obtained from local governments.
Directly Observed Therapy and Improved Tuberculosis Treatment Outcomes in Thailand  [PDF]
Amornrat Anuwatnonthakate, Pranom Limsomboon, Sriprapa Nateniyom, Wanpen Wattanaamornkiat, Sittijate Komsakorn, Saiyud Moolphate, Navarat Chiengsorn, Samroui Kaewsa-ard, Potjaman Sombat, Umaporn Siangphoe, Philip A. Mock, Jay K. Varma
PLOS ONE , 2008, DOI: 10.1371/journal.pone.0003089
Abstract: Background The World Health Organization (WHO) recommends that tuberculosis (TB) patients receive directly observed therapy (DOT). Randomized controlled trials have not consistently shown that this practice improves TB treatment success rates. In Thailand, one of 22 WHO-designated high burden TB countries, patients may have TB treatment observed by a health care worker (HCW), family member, or no one. We studied whether DOT improved TB treatment outcomes in a prospective, observational cohort. Methods and Findings We prospectively collected epidemiologic data about TB patients treated at public and private facilities in four provinces in Thailand and the national infectious diseases hospital from 2004–2006. Public health staff recorded the type of observed therapy that patients received during the first two months of TB treatment. We limited our analysis to pulmonary TB patients never previously treated for TB and not known to have multidrug-resistant TB. We analyzed the proportion of patients still on treatment at the end of two months and with treatment success at the end of treatment according to DOT type. We used propensity score analysis to control for factors associated with DOT and treatment outcome. Of 8,031 patients eligible for analysis, 24% received HCW DOT, 59% family DOT, and 18% self-administered therapy (SAT). Smear-positive TB was diagnosed in 63%, and 21% were HIV-infected. Of patients either on treatment or that defaulted at two months, 1601/1636 (98%) patients that received HCW DOT remained on treatment at two months compared with 1096/1268 (86%) patients that received SAT (adjusted OR [aOR] 3.8; 95% confidence interval [CI] 2.4–6.0) and 3782/3987 (95%) patients that received family DOT (aOR 2.1; CI, 1.4–3.1). Of patients that had treatment success or that defaulted at the end of treatment, 1369/1477 (93%) patients that received HCW DOT completed treatment compared with 744/1074 (69%) patients that received SAT (aOR 3.3; CI, 2.4–4.5) and 3130/3529 (89%) patients that received family DOT (aOR 1.5; 1.2–1.9). The benefit of HCW DOT compared with SAT was similar, but smaller, when comparing patients with treatment success to those with death, default, or failure. Conclusions In Thailand, two months of DOT was associated with lower odds of default during treatment. The magnitude of benefit was greater for DOT provided by a HCW compared with a family member. Thailand should consider increasing its use of HCW DOT during TB treatment.
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