Assessment of Directly Observed Treatment in Revised National Tuberculosis Control Programme: A Study from North India

INTRODUCTION: Directly observed treatment short-course (DOTS) strategy is one of the vital components of Revised National Tuberculosis Control Programme (RNTCP) came into existence in 1997. Directly observed treatment providers (DOT providers) are the grass root level link between program and clients. AIMS: This study was undertaken to assess the quality of DOTS and facilities available at DOT centers and association between program input and outcome. MATERIALS AND METHODS: This prospective study was carried out to evaluate RNTCP in a North Indian District. Totally, 42 DOT providers providing treatment to registered RNTCP patients in four designated microscopy centers were included in this study. Program input was assessed based on a ten-point questionnaire regarding processes and facilities followed DOT center. Treatment outcome of 302 patients receiving DOTS under these providers was also assessed. STATISTICAL ANALYSIS: Data were analyzed using SPSS version 20. Categorical variables such as age group, sex, religion, location, work experience of DOT providers are measured in frequency and percentage. Chi-square was used to find association between quality of DOTS and outcome of treatment. P < 0.05 was considered statistically significant. RESULTS: The basic principle of DOTS was followed only in half (47.6%) of the DOT centers, counseling was not being done by 40.5% of the providers. Formal training of DOTS was given to two-thirds of the providers. The treatment outcome of patients was significantly associated with program input at DOT center level (Chi-square = 4.02, P < 0.05). CONCLUSIONS: There are few gaps in DOT practices such as administration of DOTS, patient counseling, and tracing of follow-up. This study also concluded that improved program input can enable to get a better outcome.