The Dots Way Of Controlling Tb

The DOTS Way of Controlling TB Paper Presentation by Irfan Ismail Ayub. Guide – Dr. Ravi Shankar, MD., Professor, Dept of Comm Med.

Introduction DOTS in 180 countries. Adopted as the RNTCP in India. Adapted and implemented in India in 1993. Fully fledged DOTS programme in 1997. By 2005 end – 97 % coverage, thus in routine implementation phase – Category 4.

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What is DOTS ? Directly Observed treatment Short Course The control of TB in India was not successful till the establishment of the RNTCP taking DOTS as its instrument. RNTCP – 1 st phase – 1997 to 2005, was the expansive phase in India. Now in second phase – 2006 – 2010, to consolidate, widen services and sustain achievements.

Aim of RNTCP Detect 70 % of new smear positive TB. Cure 85 % of them. Implementation of DOTS.

DTC

Govt Hosp

Community Health Centres

PHC

TBC Sanotoria

OTHERS CGHS ESI Railways Religious Missions, Private Charity

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Every day in India, under the RNTCP, more than 15,000 patients are being examined for TB, free of charge. Diagnosis and follow-up of patients on treatment is achieved through examination of more than 50,000 laboratory specimens. Every day, about 3,500 patients are started on treatment, and nearly 2,500 of them are cured after treatment, More than 600,000 health care workers have been trained and more than 11,500 designated laboratory Microscopy Centres have been upgraded and supplied with binocular microscopes since the inception of the RNTCP

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DOTS Chemotherapy Category I

II

III

Type of patient

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-New sputum + -Seriouly ill – sputum (–) or extra pulm Sputum + : Relapse, Failure , after default

2 (HRZE)3 4 (HR) 3

Sputum (-), extra pulm, not seriouly ill.

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Stop TB Strategy 1. Pursue quality DOTS expansion and enhancement, by improving the case finding and cure through an effective patient-centred approach to reach all patients, especially the poor. 2. Address TB-HIV, MDR-TB and other challenges, by scaling up TB-HIV joint activities, DOTS Plus, and other relevant approaches. 3. Contribute to health system strengthening, by collaborating with other health programmes and general services

4. Involve all health care providers, public, nongovernmental and private, by scaling up approaches based on a public-private mix (PPM), to ensure adherence to the International Standards of TB care. 5. Engage people with TB, and affected communities to demand, and contribute to effective care. This will involve scaling-up of community TB care; creating demand thorugh context-specific advocacy, communication and social mobilization. 6. Enable and promote research for the development of new drugs, diagnostic and vaccines. Research will also be needed to improve programme performance.

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In 2005, more than 1290,000 cases were placed on treatment largest cohort of cases, more than any other country in the world. By March 2006, more than 5.4 million patients have been initiated on treatment, saving almost a million additional lives. The success of DOTS in India has determine the success of TB control in the world.

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