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 asuddirectly observed treatment (DOT) providers in the Revised National Tuberculosis Control Programme (RNTCP), butudtheir effectiveness has not been documented.udAim: To assess the treatment outcome and problems encountered by patients managed by different DOT providers in theudRNTCP.udMaterial and Methods: Patients diagnosed with tuberculosis at 17 Primary Health Institutions (PHIs) in TiruvallurudDistrict during a 3-year period received DOT from one of the four types of trained DOT providers (PHI staff,udgovernmental outreach workers, Anganwadi workers, community volunteers), and their treatment outcomes wereudcompared. Of the 1131 new smear-positive patients treated between May 1999 through June 2002, 199 (18%) receivedudDOT from PHI staff, 238(21%) from outreach workers, 496 (44%) from Anganwadi workers, and 170 (15%) fromudcommunity volunteers. Twenty-eight patients (2%) collected drugs for self-administration.udResults: Treatment success rates among patients treated by different DOT providers, Anganwadi workers (80%),udgovernmental outreach workers (81%), community volunteers (76%) and PHI staff (76%), were statistically similar.udPatients who received drugs for self-administration were significantly more likely to fail to treatment or die thanudpatients who were treated by a DOT provider (5/28 versus 84/1103; odds ratio=4.1; 95% confidence interval=1.2-12.6;udp=0.02).udConclusion: In addition to governmental staff, Anganwadi workers and community volunteers can be effectivelyudutilized as DOT providers.