Treatment protocol

 

India, like many other developing countries, has attempted to treat TB for decades, utilizing varying strategies and programs.   Most of them failed to make headway. This led the World Health Organization to launch a new initiative called DOTS – “Directly Observed Therapy – Short Course” in 1995, which has now become the international standard in tuberculosis treatment.


DOTS requires three essential facilities – hospitals, diagnostic centers, and treatment centers.

 


 

 

 

 

TB Hospitals: Adequate

  1. Government facilities providing comprehensive diagnostics and treatment recommendation
  2. Warehouse for medicine supplies, provided free by government & donors
  3. 1 hospital required for every 1 MM people; typically present
  1. Patient is referred here from diagnostic center
  2. Further tests such as X-ray and CT scans can be carried out
  3. Physician categorizes patient and refers to nearest DOTS center

 

 

 

Diagnostic Centers: Adequate

  1. Sputum tests for initial diagnosis and follow up tests
  2. 5 DCs required for every hospital ; typically present
  1. Sputum (+) and seriously ill patients are referred to hospital


Treatment Centers : Inadequate
  1. Local “last mile” centers, distributing medication.
  2. 5 TCs required for every DC; currently, only 1-4, with limited hours of operation
  3. Scarcity and accessibility of TCs results in high default rates, causing relapse & drug-resistance
  1. DOTS model is implemented here
  2. Patient must swallow medicine under provider supervision
  3. Patient goes here 50-60 times during therapy (6-7 months.

 

An essential element of DOTS is its “observation” component. The patient must swallow the medicine under the supervision of a DOTS provider. As a consequence, the patient has to go to the treatment center about 50 times during the course of therapy, which, on average, lasts for 7 months. Therefore, accessibility is a key issue.  However, all to often the scarcity or the distance of treatment centers prevents patients from completing their treatment.  This is why Operation ASHA is taking the treatment to the doorsteps of the patients .