Evaluation of Directly Observed Treatment Providers in the Revised National Tuberculosis Control Programme

摘要

Background: Non-governmental personnel such as Anganwadi workers and community volunteers have been used asdirectly observed treatment (DOT) providers in the Revised National Tuberculosis Control Programme (RNTCP), buttheir effectiveness has not been documented.Aim: To assess the treatment outcome and problems encountered by patients managed by different DOT providers in theRNTCP.Material and Methods: Patients diagnosed with tuberculosis at 17 Primary Health Institutions (PHIs) in TiruvallurDistrict during a 3-year period received DOT from one of the four types of trained DOT providers (PHI staff,governmental outreach workers, Anganwadi workers, community volunteers), and their treatment outcomes werecompared. Of the 1131 new smear-positive patients treated between May 1999 through June 2002, 199 (18%) receivedDOT from PHI staff, 238(21%) from outreach workers, 496 (44%) from Anganwadi workers, and 170 (15%) fromcommunity volunteers. Twenty-eight patients (2%) collected drugs for self-administration.Results: Treatment success rates among patients treated by different DOT providers, Anganwadi workers (80%),governmental outreach workers (81%), community volunteers (76%) and PHI staff (76%), were statistically similar.Patients who received drugs for self-administration were significantly more likely to fail to treatment or die thanpatients who were treated by a DOT provider (5/28 versus 84/1103; odds ratio=4.1; 95% confidence interval=l .2-12.6;p=0.02).Conclusion: In addition to governmental staff Anganwadi workers and community volunteers can be effectivelyutilized as DOT providers.