Public-Private mix in tuberculosis control: An assessment of level of implementation in Jos, Plateau State

This study is a descriptive method of research which is concerned with the relationship of the DOTS client and clinical related factor to the level of effectiveness of the DOTS program. The clinical related factor provides knowledge as to the set-up of the DOTS facility. The researchers used the correlational survey design of research since the purpose of this research study is to correlate the DOTS client and clinical related factor as to the effectiveness of the Directly Observed Treatment Short course (DOTS) for tuberculosis in terms of program administration, information dissemination, diagnostic services and medical supplies, and medical follow up. The researchers used the NTPTB register of each Rural Health Unit for the list of clients who are registered under the Directly Observed Treatment Short course strategy for the fiscal year 2010 as the respondents of this study. There were eighty-two (82) DOTS client identified and diagnosed of having tuberculosis. In the analysis and interpretation of the data, frequency count, mean and percentage are employed particularly in the interpretation of the profile of the respondents and clinical related factor. Coefficient of Correlation and T-test (test of the relationship) is used in determining the influence of the profile of the client and clinical related factor to the effectiveness of the DOTS program. The findings of the study reveal that there is a significant relationship between the profile of the clients, clinical related factors and the level of effectiveness of the Directly Observed Treatment short course program of the RHU. Keywords - Descriptive Correlation, Directly Observed Treatment Short course, Clinical Related Factors, Level of Effectiveness, Zambales, Philippines

IntroductionThe STOP TB Partnership aims to improve global tuberculosis (TB) control through expanding access to the directly observed treatment short course (DOTS) strategy. One approach to this is 'Engaging all Care Providers', which evolved from 'Public-Private Mix (PPM) DOTS'. The overall aim of this study was to systematically assess whether and to what degree the STOP TB Partnership's four global objectives of engaging all care providers are met through existing PPM interventions. These four objectives are; 1) Increase TB case detection; 2) Improve TB treatment outcomes; 3) Enhance access and equity; 4) Reduce financial burden on patients. The specific objectives of this assessment were to 1) Understand what PPM means to the STOP TB Partnership's PPM Subgroup and to National Tuberculosis Programme managers; 2) Scope the nature of existing country-level PPM interventions and 3) Review PPM practice against the global PPM objectives.MethodsWe undertook a systematic, multi-facetted assessment. The methods included interviews with National Tuberculosis Programme managers from high burden countries, clarification of key issues with the STOP TB Partnership PPM secretariat and a review of publicly accessible reports and published articles on PPM projects. Both the literature review and interviews with the National Tuberculosis Programme managers yielded data on project characteristics; PPM models at country level; National Tuberculosis Programme partners; and mechanisms for engagement. Matrices were developed from the literature review and the interviews to show the relationship between services and service providers for different PPM projects. Data from the literature were assessed against each of the four global PPM objectives.ResultsTwelve National Tuberculosis Programme managers from high burden countries were interviewed about the scope of PPM partnerships. Understanding of PPM and types of engaged providers varied considerably; 'private-for-profit qualified clinical providers' were the dominant category. The literature review yielded information on 22 projects in which 'private-for-profit qualified clinical providers' were again the dominant category. The contributions made by 'private-for-profit qualified clinical providers' and 'Non Governmental Organisation qualified clinical providers', were assessed against the four global PPM objectives. Reporting on tuberculosis case detection and treatment outcomes was generally good and demonstrated important PPM contributions in these areas. Reporting on equity, access and reduced patient costs was often lacking or inconclusive.ConclusionsPPM has improved case detection and treatment outcomes among patients seeking care with private providers. Evidence on reducing patient costs is inconclusive, and there is scope for increasing equity in access to care by systematically engaging those providers who are the primary agents for poor people seeking health care. Guidelines outlining which types of providers best contribute to achieving the four global objectives, along with the resources required by National Tuberculosis Programs for such engagement is needed.

Tuberculosis is a common respiratory disease imposing significant health burden. Directly observed treatment short course strategy ensures patient compliance in tuberculosis treatment. The aim of this study was to assess pattern of tuberculosis, trend and outcome of patients registered at Directly observed treatment short course centre of Tribhuvan University Teaching Hospital. A retrospective observational study was conducted at Tribhuvan University Teaching Hospital. Tuberculosis patients of all age groups registered from July 2017 to June 2020 at Tribhuvan University Teaching Hospital Directly observed treatment short course centre were included. Data entry and analysis was done in SPSS version 20.0. Descriptive statistics was performed and results were interpreted in mean, frequency and percentage. A total of 2790 tuberculosis patients were included for final analysis. There were 1736 (62.2%) males. Mean age of patients was 37.94±20.28 years. Pulmonary tuberculosis was the most common type of tuberculosis seen in 948 (34%) patients. Fifty percent of total tuberculosis cases were confined to thorax. Tubercular pleural effusion and pleurisy (14.6%), central nervous system (13.2%), bone and joint (12.2%) were common forms of extrapulmonary tuberculosis. The mean incident tuberculosis cases registered annually was 697.5±95.63. Nearly half (49.1%) of the patients completed tuberculosis treatment regimen while 43.3% were referred to other Directly observed treatment short course centre as per their convenience. This study reflects the trend and pattern of tuberculosis epidemiology at tertiary care hospital of Nepal. There is a huge burden of both pulmonary and extrapulmonary tuberculosis at Tribhuvan University Teaching Hospital with slight annual variation in incident tuberculosis cases. Despite implementation of Directly observed treatment short course, the problem of non-compliance persists among the tuberculosis patients.

Ethiopia has a growing private health sector. In recent years, the directly observed treatment short course (DOTS) strategy was initiated in selected private health facilities in the country. The objective of the present study was to assess knowledge and practice of private practitioners in tuberculosis (TB) control in Amhara Region, Ethiopia. An institution-based cross-sectional study was conducted among 112 private practitioners selected from all private health facilities in the region. The study was conducted between May and August 2008 and data was collected using a semi-structured questionnaire. Group differences were analyzed using the chi-square test. Fifty-nine (52.7%) of the private practitioners suspected TB in patients with three weeks' duration of cough. Only 37 (33.0%) of the private practitioners were able to precisely list the correct treatment regimens for all categories as recommended in the National Tuberculosis and Leprosy Control Program guidelines. The correct frequency of TB treatment monitoring was provided by 44 (50%) of the respondents.Overall 44 (39.3%) of the private practitioners did not have satisfactory knowledge about the directly observed treatment short course (DOTS) strategy. Those who attended DOTS training during the two years prior to the survey were more likely to have satisfactory knowledge compared to those who did not receive training (OR 4.45, 95% CI: 1.33, 14.87, p < 0.02). A significant proportion of private practitioners did not have satisfactory knowledge and practice about DOTS. The provision of regular DOTS refresher courses improves TB management for patients in the region.

Η φυματίωση τα τελευταία χρόνια αποτελεί ένα επιδεινούμενο πρόβλημα δημόσιας υγείας ανά την υφήλιο, με επίπτωση παγκοσμίως για το 2007 139/100.000 πληθυσμό, ενώ για την Ευρώπη 54/100.000 και για την Ελλάδα 5,9/100.000 πληθυσμό. Στην παρούσα μελέτη έγιναν αρχικά δύο επιδημιολογικές έρευνες που αφορούσαν: α) την επιδημιολογία της φυματίωσης στη Δυτική Ελλάδα και την αξιολόγηση της πληρότητας των υποχρεωτικών δηλώσεων (2000-2003) καθώς και β) την εκτίμηση του δείκτη διαμόλυνσης σε μαθητικό πληθυσμό του Νομού Ηλείας (1994-2000). Σκοπός μας ήταν να περιγραφεί και να αναλυθεί η επιδημιολογία της φυματίωσης στη Δυτική Ελλάδα (Νομοί Ηλείας, Αχαΐας, Αιτωλοακαρνανίας) καθώς και να αξιολογηθεί η εξέλιξη του δείκτη διαμόλυνσης της φυματίωσης στο νομό Ηλείας, στα πλαίσια πρόληψης της νόσου. Εν συνεχεία, μελετήθηκε η εφαρμογή της Άμεσα Επιτηρούμενης Θεραπείας (DOTS) σε 13 νεοδιαγνωσθέντες ασθενείς με φυματίωση (2006-2009), συγκριτικά με την έκβαση 41 πρώην διαγνωσθέντων ασθενών (μάρτυρες) χωρίς ΑΕΘ, όλοι κάτοικοι του Νομού Ηλείας, με απώτερο σκοπό την αξιολόγηση της αποτελεσματικότητας της εφαρμογής του DOTS, συγκριτικά με την έως τώρα συντηρητική αντιμετώπιση των ασθενών με ΤΒ. Για την ολοκλήρωση της μελέτης υπήρξε συνεργασία του Πνευμονολογικού Ιατρείου του Γ.Ν. Πύργου με τον ειδικά εκπαιδευμένο Γενικό/Οικογενειακό Ιατρό, ο οποίος πραγματοποιούσε τις κατ΄ οίκον επισκέψεις στις οικογένειες ασθενών και μαρτύρων. Αναφορικά με την έρευνά μας στη Δυτική Ελλάδα, η μέση ετήσια επίπτωση βρέθηκε να είναι 5,4 ανά 100.000 άτομα ενώ τα επίσημα στοιχεία από το ΚΕΕΛΠΝΟ παρουσιάζουν μόνο 3,8 κρούσματα ανά 100.000 πληθυσμό. Στην μελέτη μυκοβακτηριδιακής διαμόλυνσης για τον μαθητικό πληθυσμό του νομού Ηλείας, συγκρίνοντας τις δύο τριετίες 1994-1996 και 1998-2000, ο Μ.Ο. εξάπλωσης του ΔΜΔ για τους μαθητές του Δημοτικού μειώθηκε από 0,7% σε 0,16%, ενώ στους μαθητές του Γυμνασίου παρατηρήθηκε μια μικρή πτώση, από 2,51% σε 2,41%. Με βάση τις διεθνείς οδηγίες, η θεραπευτική αντιφυματική αγωγή αποτελείται από INH, RIF, PZA και EMB για 2 μήνες και για τους επόμενους 4 μήνες χορηγούνται μόνο INH και RIF. Κατόπιν αξιολόγησης των αποτελεσμάτων της προοπτικής μας μελέτης υπό το πρόγραμμα DOTS, προκύπτει ότι τα ποσοστά επιτυχούς θεραπείας ήταν 84,6% (προσεγγίζοντας το κατώτερο 85% που έχει θέσει ο WHO). Αξίζει να σημειωθεί, ότι ένας ασθενής (7,7%) απεβίωσε και ένας (7,7%) εξαφανίστηκε, λόγω αλλαγής πόλης στην οποία εργαζόταν. Αντίθετα, για τους μάρτυρες μόνο το 75,6% επιβεβαιώνουν αποτελεσματικότητα της θεραπείας. Σχετικά με τη νοσηρότητα των μελών, από τους 30 συγγενείς – μέλη των ασθενών, οι 4 (13,3%) χρειάστηκαν χημειοπροφύλαξη, ενώ από τους 111 συγγενείς – μέλη των μαρτύρων, οι 14 (12,6%) χρειάστηκαν χημειοπροφύλαξη και οι 7 (6,3%) νόσησαν και έλαβαν θεραπεία. Συμπερασματικά, η σωστή αντιμετώπιση του προβλήματος δεν έγκειται μόνο στην έγκαιρη διάγνωση και θεραπεία, αλλά και στην αξιόπιστη καταγραφή των κρουσμάτων που θα μας ευαισθητοποιήσουν στο να αντιληφθούμε την πραγματικά ανησυχητική διάσταση του προβλήματος και να χρησιμοποιήσουμε αποτελεσματικότερους τρόπους πρόληψης και αντιμετώπισης. Η άμεσα επιτηρούμενη θεραπεία, στοχεύει όχι μόνο στη σωστή παρακολούθηση και ίαση των ασθενών με φυματίωση, αλλά και στην εκπαίδευση των μελών των οικογενειών τους σε θέματα πρόληψης και βελτίωσης των επιβαρυντικών παραγόντων διαβίωσης, μειώνοντας σημαντικά τη νοσηρότητα του πληθυσμού.

Objective: To rank diagnostic features of childhood pulmonary tuberculosis; and to determine the effect of working in tuberculosis Directly Observed Treatment Short Course (DOTS) facilities on the ranking of these features by medical doctors. Methods: A cross sectional descriptive study, using structured questionnaires to collect data from medical doctors whose daily routine included attending to sick children in 34 selected children outpatient clinics and TB DOTS centers in southeastern Nigeria. Results: Approximately, one quarter (25.3% or 56 of 221) of respondents worked in Directly Observed Treatment Short course (DOTS) clinics, while three quarters (74.7% or 165 of 221) worked in nonDOTSclinics. Majority of the respondents (69.7%) ranked chronic persistent cough (1), 42.5 % ranked weight loss and failure to thrive (2), another 27.7% ranked weight loss and failure to thrive (3), while 17.6% and 21.7% ranked History of contact with adult index case and radiographic abnormalities, (4) and (5), respectively. The study found that the percentage of doctors working in DOTS clinics who ranked weight loss and failure to thrive (2) was statistically and significantly higher than those of non-DOTS respondents. Conclusions: The most important symptoms/signs on which medical doctors based their diagnosis of childhood pulmonary tuberculosis include cough, weight loss and failure to thrive, history of contact with adult with smear positive pulmonary tuberculosis, and radiographic abnormalities consistent with active tuberculosis. There was statistically significant difference between the ranking of weight loss and failure to thrive by doctors working in DOTS clinics and their counterparts in non DOTS clinics. This study showed a decline in the percentage of ranking in both DOTS and Non DOTS respondents as they moved from the first to the fifth. KEY WORDS: Childhood pulmonary tuberculosis, Doctors, Ranking, Diagnostic features, Directly observed treatment short course (DOTS).

Treatment outcome of tuberculosis patients under directly observed treatment in Addis Ababa, Ethiopia

Directly observed treatment short course (DOTS) and self-administered therapy (SAT) are the treatment options available for tuberculosis (TB). Studies conducted worldwide have shown difference in treatment outcome with these two treatment modalities. The study was undertaken to compare treatment outcome of DOTS and SAT in patients of pulmonary TB taking SAT from a tertiary care hospital and DOTS from the DOTS centre of a government hospital. It was a retrospective comparative study. The case record files of patients with pulmonary TB diagnosed from March 2011 to February 2012 were analysed as per the proforma. The sample size of patients was 150 (75 each from DOTS and SAT). The treatment outcome in DOTS group was cured 70.7%, treatment completed 1.3%, failure 5.3%, deaths 10.7%, defaulters 8% and transferred out 4% whereas in SAT group, cure was seen in 68% and 4% completed the treatment, 1.3% had treatment failure, and 26.7% were lost to follow up which included deaths, defaulters and those patients who switched over to other hospitals. The treatment success rate was similar (72%) in both groups. There was no statistically significant difference observed in the average weight gain at the end of treatment between the two groups. A total of 11 adverse drug reactions (4 DOTS, 7 SAT) were recorded in the study. The study shows no statistically significant difference between success rate in patients taking DOTS and SAT.

Background: Directly observed treatment short course (DOTS) is a cornerstone of Revised National Tuberculosis Control Program of India. Adverse drug reactions (ADRs) induced by this therapy is common and it causes significant morbidity and mortality. Hence, the present study was undertaken to determine the incidence and pattern of ADRs and to assess causality and severity. Methods: We conducted prospective, observational study at DOTS center of tertiary care hospital, Pune. 150 pulmonary tuberculosis patients undergoing DOTS therapy were enrolled. They were monitored weekly in an intensive phase and monthly in the continuation phase. The suspected ADRs were recorded and assessed for causality and severity by standard algorithms. Results: Incidence of ADRs due to DOTS was 19.33% &amp; total 35 ADRs had occurred in our study. Gastrointestinal intolerance, arthralgia &amp; itching with or without rashes were most common ADRs (incidence rates: 12.67%, 2.67% and 2.67%, respectively). On evaluation of causality by Naranjo algorithm, majority of ADRs 91.43% were “possible.” As per WHO- Uppsala Monitoring Center scale, majority of ADRs 91.43% were “possible.” As per Modified Hartwig and Siegel scale, majority of ADRs were “moderate” (48.57%) but 8.57% were “severe.” Female gender was found to be a significant risk factor for developing ADRs (odds ratio: 3.08, 95% confidence interval: 1.33-7.12. 3.33%). ADRs &amp; hepatotoxicity was major reason for defaulting from DOTS (60%). Conclusion: ADRs induced by DOTS are common and there is need of incorporating pharmacovigilance system for this vital public health program. Counseling of patients for timely prevention, detection, and management of ADRs will help in minimizing the further occurrence of ADRs.

Objective: To find the impact of Tuberculosis disease upon quality of life of patients who undergo Directly Observed Treatment Short Course (DOTS). Methodology: A descriptive design is carried out at Respiratory and Chest Diseases out Patients' Clinic, of Nov 20th, 2012 to July 11th, 2013, in order to find out the impact of tuberculosis disease upon quality of life of patients who undergo Directly Observed Treatment Short Course (DOTS). A non-probability (Purposive) sample of (60) Tuberculosis patients. The data collection process has been performed in February 13th, 2012 to the April 6th, 2012. The data were described analyzed through the use of descriptive statistics such as (frequencies, percentage, mean of score and comparative significant) and inferential statistics such as (Chi-square, and T-test). Results: The results of the study showed that Tuberculosis negatively influence upon patients quality of life domains. Conclusion: The study concludes that the maximum effect of presented by the social domain, followed by the psychological, level of independency, then the physical domain. While the minimum impact, presented by spiritual domain, followed by the environmental domain. Recommendation: The study recommended that necessary to do a health educational programs to increase health awareness among peoples who attendants the outpatient clinics and special health centers for tuberculosis disease, as well as the use of mass media by the health authorities.

Background: Defaulting from Directly Observed Treatment Short Course (DOTS) is a big challenge to the effective control of TB. There are no published data on defaulting from DOTS in Benin City which necessitated this study to determine the rate of defaulting and identify factors that significantly contribute to defaulting in Benin City, Nigeria. Methods: This was a case control study from August to December 2011 of 1253 TB patients placed on DOTS in Benin City. The two DOTS centres used for the study were situated in University of Benin Teaching Hospital (UBTH) and Egor local government secretariat, both in Egor local government area (LGA) in Benin City. Out of 1253 patients registered on DOTS in the two study centres, 722 patients comprising of 172 defaulters and 550 non- defaulters were selected for the study using the inclusion and exclusion criteria. Logistic regression analysis was performed to determine association between independent variables and defaulting. Results: The default rate was 23.8%. Defaulting was significantly associated with: male sex (OR 3.05; 95%CI 1.60 - 5.80), being married (OR 3.06; 95%CI 1.34 - 6.99), a history of travel (OR 6.87; 95%CI 3.19 - 14.80) and concomitant drug use with TB drugs (OR 1.95; 95%CI 1.02 - 3.73). Conclusion: The default rate from DOTS in Benin City and the factors significantly associated with defaulting have given us some information initially unavailable about defaulting from DOTS in Benin City. TB control programmes taking these factors into consideration need to be done to promote compliance to treatment.

Tuberculosis related stigma attached to the adherence of Directly Observed Treatment Short Course (DOTS) in West Bengal, India

Background: India has the highest burden of tuberculosis (TB) despite it being one of the oldest diseases. Defaulting from antitubercular therapy is one of the challenges in the control of TB. Objectives: To study the sociodemographic profile and outcome of TB patients registered under Directly Observed Treatment Short course (DOTS) in East Sikkim from 2009 to 2011, with reference to defaulters. Methods: In this cross-sectional study, primary data were obtained by interviewing defaulters (only 32 out of total 46 defaulters). Secondary data for all defaulters were obtained from district TB registers. Data were entered into excel sheet and analyzed (Limitation of the study: All 46 defaulters could not be interviewed). Results: The defaulters were more commonly from category II of DOTS with an equal male:female ratio with most common age group of defaulters being 20–39 years. The most common timing of default was the early intensive phase and the early continuation phase. The reasons for default were usually multiple in most with consumption of alcohol, relief of symptoms, and migration being the most common. Out of the 46 defaulters, 10 patients were retrieved back, 5 patients were started on non-DOTs therapy, 7 patients expired, 8 patients migrated out, 10 patients were lost to follow-up, and rest 6 patients could not be traced. Conclusions: Causes of default are usually multiple, and most cases are preventable/rectifiable. Some flexibility with respect to drug administration and strengthening in DOTS program by reviewing it at regular intervals will go a long way in further.

Background:The engagement of private practitioners in the public-private mix of tuberculosis (TB) management started in 2007 in Lagos State Nigeria. This study compared the treatment outcomes of patients managed at private for profit (PFP) and private not for profit (PNFP) directly observed treatment short course (DOTS) facilities.Methods:A retrospective review of treatment cards of TB patients managed between January 1, 2012, and June 30, 2012, in seven PFP and four PNFP DOTS facilities that served as treatment and microscopy center under the Lagos State TB and Leprosy Control Programme (LSTBLCP) at least 2 years before data collection was conducted.Results:A total of 372 treatment cards of TB patients were reviewed, of which 132 (35.5%) and 240 (64.5%) were from PFP and PNFP DOTS facilities, respectively. Treatment success rate was higher among patients managed at PFP (89.4%) DOTS facilities than PNFP (81.3%) DOTS facilities (P = 0.04). The proportion of patients lost to follow-up (12.5% vs. 8.3%), dead (3.3% vs. 1.5%) and treatment failure (2.5% vs. 0.8%) was higher among patients managed at PNFP DOTS facilities (P > 0.05). The odds that patients treated at PFP DOTS facilities had treatment success were about four times higher than PNFP DOTS facilities when other variables have been controlled for (P < 0.05).Conclusion:There is need by the LSTBLCP to engage more private practitioners to increase case detection and improve treatment outcomes of TB patients.

Decadal impact of Directly Observed Treatment Short course program on age and gender among New Infectious Tuberculosis cases in Delhi