Abstract
BackgroundLimited data are available about tuberculosis treatment models of care for internally displaced populations in chronic, low-intensity conflict zones. This study aimed to detail experiences of a Médecins Sans Frontières tuberculosis programme in Andhra Pradesh-Chhattisgarh border area, India, from January to December 2012.MethodsThe study was a description of two retrospective, observational cohorts receiving category I tuberculosis treatment, either intermittent directly observed treatment (DOT) or daily self-administered therapy (SAT) depending on the security of the area and access to health care services.ResultsA total of 55 and 17 new tuberculosis patients under DOT and SAT respectively, with complete outcomes were included in the study. Most patients registered were new cases suffering from pulmonary, smear-positive tuberculosis. More than half of the patients in both cohorts were cured or completed treatment: 38/55 (69%) patients were successfully treated under DOT compared to 9/17 (53%) under SAT. Of the patients with adverse outcomes, the ratios of loss to follow up: failure: died were 10∶4:3 under DOT and 7∶0:1 under SAT. A much smaller proportion of patients under DOT (18%) were lost to follow up than under SAT (41%).DiscussionMaximum efforts are required to implement successful tuberculosis control programmes for internally displaced populations in conflict zones. Our study suggests that complete tuberculosis treatment can be given to patients using either intermittent DOT or daily SAT, depending on security and access to health services. National TB programmes should include SAT strategies for tuberculosis treatment as these may be an alternative feasible option in conflict settings.
Highlights
India contributes to a large share of the global tuberculosis (TB) burden
Fifty-five and 17 new tuberculosis patients under directly observed treatment (DOT) and self-administered therapy (SAT) respectively were on category I treatment and were included in the study (Table 1)
Males were in majority in both the regions: 35/55 (64%) in DOT and 10/17 (59%) in SAT areas
Summary
India contributes to a large share of the global tuberculosis (TB) burden. Of the global annual incidence of 9 million TB cases, 2.3 million cases are estimated to occur in India [1]. The estimated incidence of smear-positive tuberculosis cases in 2012 for Andhra Pradesh (AP) and Chhattisgarh (CG) was approximately 52 and 90 smear-positive cases per 100,000 population respectively. Limited data are available about TB treatment outcomes within internally displaced populations (IDPs) in chronic, low-intensity conflict zones in the border areas of these two neighbouring states. There remains a significant proportion of people in India without access to permanent health structures and/or to health care workers that can serve as DOT providers: internally displaced people in conflict zones in border areas and tribal populations are two such groups. Limited data are available about tuberculosis treatment models of care for internally displaced populations in chronic, low-intensity conflict zones. This study aimed to detail experiences of a Medecins Sans Frontieres tuberculosis programme in Andhra Pradesh-Chhattisgarh border area, India, from January to December 2012
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