Abstract

Vibhu Parcha*, Sakshi Jaryal and Parveen Kumar Sharma

ABSTRACT

Background: DOTS forms the core of the Revised National Tuberculosis Control Programme (RNTCP)-Stop TB Strategy and is implemented through DOTS Centers and Treatment Supporters that act as focal point of delivery of preventive, promotive and curative services under the programme. Despite this efficacy of DOTS implementation is not well evidenced in literature. Objectives: To assess the functioning of DOTS Centers and knowledge of Treatment Supporters in District Kangra of Himachal Pradesh. Methods: Assessment of organization and working conditions, TB Register, Treatment records and drug storage area of 4 randomly selected DOTS Centers was done using structured performa over a period of 2 months. Questionnaire based interview of Treatment Supporters to assess their knowledge was done. Patient interviews were carried out to corroborate and refine the findings of the study. Results and Discussion: Although the overall implementation of RNTCP-DOTS is reasonably acceptable but there still are gaps in the theoretical structure of Tuberculosis diagnosis and treatment and its ground level execution which must be addressed effectively to achieve the goal of ‘TB Free India’. Follow-up sputum microscopy was delayed by 3-4 weeks in many cases while the patient had been started on Continuation Phase of treatment which may lead to delay in identifying and probable subsequent increase in (Multidrug Resistant) MDR-TB cases. Patients are inconvenienced in terms of time and distance of the facility, which may result in eventual loss to follow-up (LFU). There are no Community/TB Support groups for the patients pointing towards a lack of social support system which otherwise helps in reducing LFU rates. Treatment records are written illegibly and poorly maintained. The drug storage facility is in gross neglect in all centers with insufficient stock of drugs in some centers.