Community mediated domiciliary dots execution-a study from New delhi

摘要

Background: Directly Observed Treatment-Short Course (DOTS) strategy has been successful in global tuberculosis (TB) control. However, a few patients may have their reasons for non-acceptance of Directly Observed Treatment (DOT) despite the agreement with strategy in principle. A need exists for identifying the community DOTS providers for such patients, who could assist in their treatment delivery at the either-one's residence.Aim: The study was carried out to determine feasibility, acceptability and efficacy of domiciliary DOTS execution to TB patients through services of community DOTS providers.Method: The study was prospectively carried out on those TB patients residing in New Delhi, who visited Institute between February 2001-January 2002 and were unable to accept DOTS due to a specific reason. Each of them identified a provider from the community, who could assist in a domiciliary DOTS execution at the residence of patient or provider. Result: Out of 3127 TB patient-registrations over 1 year study-period, community DOTS providers were identified for the domiciliary DOTS treatment of 52 patients (about 2%), who were themselves unable to visit the cer tres owing to either inconvenient centre-timings mingling with job, study or household work (43), unavailability of nearby DOTS centres (4), social stigma (3) or physical disabilities (2). Most providers volunteering for such treatment executions were neighbours of patients and did so owing to human considerations. The DOTS was self-indicated as treatment of disease by 25 (48%) patients and 24 (46%) providers. Existing TB knowledge of incumbents increased significantly following the motivation by physicians. Sputum conversion at end of intensive phase occurred in 10 (91%) patients, while overall treatment success of study was observed to be 98% which was significantly better than that observed in the other patients treated at DOTS centres of Institute. No major problem was encountered during the treatment execution through providers. Conclusion : Community DOTS providers were able to carry out a successful domiciliary DOTS execution in TB patients, who were unable to accept the treatment due to specific reasons. Number of incumbents having DOTS awareness was noteworthy and knowledge about disease increased further through physician's motivation.