Directly Observed Therapy Short-Course Strategy Research Articles

Telenursing Intervention for Pulmonary Tuberculosis Patients - A Scoping Review.

Management of care for people with Pulmonary TB at home using Information and Communication Technology (ICT) tools and innovative approaches, such as tools for telecommunications online education. In the nursing sector, the use of telecommunications is called telenursing. The purpose of this study is to determine the types of telecommunications-based interventions, especially telenursing, in monitoring the level of treatment adherence in patients with pulmonary TB. This study used a scoping review method approach to determine the type of telecommunications-based interventions, especially telenursing, in monitoring the level of treatment adherence in patients with pulmonary TB. Literature distribution using several sources, namely EBSCOhost, Scopus (Elsevier), and PubMed. To facilitate obtaining appropriate literature, PICO techniques are used in conducting literature searches, P (population/problem/patient), I (intervention, prognostic factor, exposure), C (comparison, control), and O (outcome). Keywords used in English "Tuberculosis OR Pulmonary Tuberculosis AND Telehealth OR Telehealth Nursing AND Medication Adherence OR Medication Compliance OR Behavior". In total from the 13 articles obtained, the articles used several telehealth to pulmonary TB patients with various implementations, such as the Directly Observed Therapy, Short Course (DOTS) (n = 7). These four implementations have the same goal and support adherence to taking medication and daily recovery in pulmonary TB patients. Overall characteristics of pulmonary TB patients in the reviewed articles are pediatric TB patients (0-14 years), adult TB (18-30 years). A total of 9 studies used a sample population of adult TB patients (18-30 years), TB undergoing Directly Observed Treatment Short-course (DOTS), TB receiving medical care and TB patients actively receiving treatment. The most influential effectiveness of telehealth in helping the treatment process of Pulmonary TB patients is Directly Observed Treatment Short-course (DOTS) because the main focus of the DOTS strategy is patient discovery and cure, priority is given to infectious TB patients without ruling out other types of TB.

Factors associated with the unsuccessful TB treatment outcomes in the northern regions of Namibia: a mixed methods study

BackgroundTuberculosis (TB) is among the leading causes of death globally. The disease has a huge burden in Namibia, with a case notification rate of at least 442 per 100,000. To date, Namibia is among the countries with the highest global TB burden, despite all efforts to reduce it. This study aimed to determine the factors associated with the unsuccessful treatment outcomes of the Directly Observed Therapy Short course (DOTS) programme in the Kunene and Oshana regions.MethodsThe study utilised a mixed-methods explanatory-sequential design to collect data from all TB patient records and healthcare workers who work directly with the DOTS strategy for TB patients. The relationship between independent and dependent variables was analysed using multiple logistic regression analysis, while interviews were analysed using inductive thematic analysis.ResultsThe overall treatment success rates of the Kunene and Oshana regions throughout the review period were 50.6% and 49.4%, respectively. The logistic regression analyses showed that in the Kunene region, the type of DOT used (Community-based DOTS) (aOR = 0.356, 95% CI: 0.835–2.768, p = 0.006) was statistically significant with the unsuccessful treatment outcomes. While in the Oshana region, age groups 21–30 years old (aOR = 1.643, 95% CI = 1.005–2.686, p = 0.048), 31–40 years old (aOR = 1.725, 95% CI = 11.026–2.9, p = 0.040), 41–50 years old (aOR = 2.003, 95% CI = 1.155–3.476, p = 0.013) and 51–60 years old (aOR = 2.106, 95% CI = 1.228–3.612, p = 0.007) had statistically significant associations with the poor TB-TO. Inductive thematic analysis revealed that patients in the Kunene region were challenging to reach owing to their nomadic lifestyle and the vastness of the area, adversely affecting their ability to observe TB therapy directly. In the Oshana region, it was found that stigma and poor TB awareness among adult patients, as well as mixing anti-TB medication with alcohol and tobacco products among adult patients, was a prevalent issue affecting TB therapy.ConclusionThe study recommends that regional health directorates embark on rigorous community health education about TB treatment and risk factors and establish a robust patient observation and monitoring system to enhance inclusive access to all health services and ensure treatment adherence.

Determinants of tuberculosis treatment support costs to the treatment supporters in rural Ghana.

The Ghana Health Service has been implementing the Directly Observed Therapy Short Course (DOTS) strategy for decades now, to cure and reduce the transmission of tuberculosis. DOTS strategy requires TB patients and their treatment supporters to make multiple clinic visits in the course of treatment, and this may place financial burden on treatment supporters with low socio-economic status. However, the determinants of tuberculosis treatment support costs to treatment supporters are unknown in Ghana. This study determined the costs associated with treatment support to the treatment supporters in Bono Region, Ghana. In a cross-sectional study using cost-of-illness approach, 385 treatment supporters were selected and interviewed. A validated questionnaire for the direct and indirect costs incurred was used. Descriptive statistics and bivariate techniques were used for data analysis. Averagely, each treatment supporter spent GHS 122.4 (US$ 21.1) on treatment support activities per month, which is about 19% of their monthly income. The findings also revealed that highest level of education, household size, monthly income and district of residence were significant predictors of the direct costs. On the other hand, gender of the respondents, highest level of education, ethnicity, household size, income level and relationship with patient were some of the factors that significantly influenced the indirect costs. The significance levels were set at a 95% confidence interval and p < 0.05. The study concludes that the estimated cost associated with assisting tuberculosis patients with treatment is significant to treatment supporters. If these costs are not mitigated, they have the tendency of affecting the socio-economic status and welfare of individuals assisting tuberculosis patients with treatment.

Complete sputum smear monitoring among adults with pulmonary tuberculosis in central Uganda: evidence from a retrospective cohort study

BackgroundPeople with bacteriologically confirmed pulmonary tuberculosis require sputum smear monitoring at 2, 5, and 6 months to establish treatment outcomes. However, there is limited information about sputum smear monitoring in Uganda, similar to other developing countries. We examined factors associated with complete sputum smear monitoring among persons with bacteriologically confirmed pulmonary TB aged ≥ 15 years in central Uganda.MethodsWe retrospectively reviewed and abstracted data for persons with bacteriologically confirmed pulmonary TB initiated on treatment between January 2017 and December 2019 across 11 large TB units in Masaka district in central Uganda. Complete sputum smear monitoring was measured as the receipt of three sputum smear microscopy tests at 2, 5, and 6 months of TB treatment. The data were summarized descriptively and the differences in the outcome with independent variables were examined using tests of statistical significance, namely the Chi-square or Fisher’s exact test and the student’s t-test. The factors independently associated with the outcome were established using the modified Poisson regression analysis with robust standard errors, reported as adjusted risk ratio (aRR) along with the 95% confidence interval (CI).ResultsA total of 416 participants were enrolled, with a mean age of 37.3 ± 12.9 years. Of the participants, 290 (69.7) were males, 269 (64.7) were rural residents, and 128 (30.8%) had complete sputum smear monitoring. Urban residence (aRR, 1.45; 95% CI 1.12–1.90) and treatment under the community-based directly observed therapy short-course strategy (DOTS) (aRR, 1.91; 95% CI 1.25–2.92) were associated with a higher likelihood of complete sputum smear monitoring while TB and human immunodeficiency virus (TB/HIV) comorbidity (aRR 0.45, 95% CI 0.30–0.68) was associated with a lower likelihood of complete sputum smear monitoring.ConclusionsWe found a low magnitude of complete sputum smear monitoring among persons with bacteriologically confirmed pulmonary TB aged ≥ 15 years in central Uganda. Strategies to enhance the performance of sputum smear monitoring should target rural health facilities, strengthen TB/HIV collaboration and the implementation of community-based DOTS.

"I am afraid that others will feel scared and disgusted with me. So, I will keep it a secret until I die": A qualitative study among patients with tuberculosis receiving DOTS regimen in Thailand.

Tuberculosis (TB) has become a significant public health problem leading to a top ten morality. Directly Observed Therapy, Short-course (DOTS) is recommended as a critical element for curing and preventing TB. However, patients who have been living with TB often receive barriers and challenges, which may lead them to discontinue the DOTS treatment. This study aimed to understand patients' experiences living with TB and receiving DOTS regimens. A qualitative descriptive study was employed. Semi-structured interviews were done among twenty tuberculosis patients selected using convenience sampling from the slum community in Bangkok, Thailand. The thematic approach was used for data analysis. Two main themes were developed: (1) troublesome disease and (2) emotional challenges. The first theme comprises three subthemes: confronting death, accepting lifestyle change, and DOTS challenges. The second theme consists of two subthemes: isolation from others and stigma. The findings could guide nurses and other healthcare professionals to develop the treatment guideline and the DOTS strategy using a holistic approach.

Tuberculosis treatment outcomes and associated factors in two states in Nigeria

To determine the treatment success rate among TB patients and associated factors in Anambra and Oyo, the two states with the largest burden of tuberculosis in Nigeria. A health facility record review for 2016 was conducted in the two states (Anambra and Oyo). A checklist was used to extract relevant information from the records kept in each of the selected DOTS facilities to determine TB treatment success rates. Treatment success rate was defined as the proportion of new smear-positive TB cases registered under DOTS in a given year that successfully completed treatment, whether with bacteriologic evidence of success ('cured') or without ('treatment completed'). Treatment success rate was classified into good (≥85%) and poor (<85%) success rates using the 85% national target for TB treatment outcome. Data were analysed using descriptive statistics and chi-square at P<0.05. There were 1281TB treatment enrollees in 2016 in Anambra and 3809 in Oyo (total=4835). An overall treatment success rate of 75.8% was achieved (Anambra-57.5%; Oyo-82.0%). The percentage cure rates were 61.5% for Anambra and 85.2% for Oyo. Overall, only 28.6% of the facilities in both states (Anambra-0.0%; Oyo-60.0%) had a good treatment success rate. More facilities in Anambra (100.0%) than Oyo (40.0%) had a poor treatment success rate (p<0.001), as did more private/FBO (100.0%) than public health facilities (60.0%) (p=0.009). All tertiary facilities had a poor treatment success rate followed by 87.5% of secondary health facilities and 56.5% of primary healthcare facilities (P=0.035). Treatment success and cure rates in Anambra state were below the 85.0% of the recommended target set by the WHO. Geographical location, and level/tier and type of facility were factors associated with this. Interventions are recommended to address these problems.

Predictors of tuberculosis treatment success under the DOTS program in Namibia

ABSTRACTObjectives: Optimal treatment success rates are critical to end tuberculosis in Namibia. Despite the scale-up of high quality directly observed therapy short-course strategy (DOTS) in Namibia, treatment success falls short of the global target of 90%. The objective of this study was to ascertain the predictors of treatment success rates under DOTS in Namibia to provide future direction.Methods: A nation-wide comparative analysis of predictors of treatment success was undertaken. Tuberculosis cases in the electronic tuberculosis register were retrospectively reviewed over a 10-year period, 2004–2016. The patient, programmatic, clinical, and treatment predictors of treatment success were determined by multivariate logistic regression modeling using R software.Results: 104,603 TB cases were registered at 300 DOTS sites in 37 districts. The 10-year period treatment success rate was 80%, and varied by region (77.2%–89.2%). The patient’s sex and age were not significant predictors. The independent predictors for treatment success as were: Region of DOTS implementation (p=0.001), type of directly observed treatment (DOT) supporter (p<0.001), sputum conversion at 2 months (p=0.013), DOT regimen (p<0.001), cotrimoxazole prophylaxis (p=0.002), and HIV co-infection (p=0.001).Conclusion: Targeted programmatic, clinical and treatment interventions are required to enhance DOTS treatment success in Namibia. These are now ongoing.

Treatment Outcome of Tuberculosis Patients and Associated Risk Factors at Dessie and Woldiya Town Health Institutions, Northeast Ethiopia: A Retrospective Cross Sectional Study

Background: Ethiopia introduced directly observed therapy short-course (DOTS) strategy for TB in 1995; reaching its full coverage in 2005. Treatment success rate (TSR) was 84% in 2009 and dropped to 83% in 2010. Despite the progress made in tuberculosis control throughout Ethiopia, risk factors leading to poor treatment outcome have not been assessed in Dessie and Woldiya town health institutions. Therefore, this study aimed to determine treatment outcome of TB patients and risk factors for poor treatment outcome in Dessie and Woldiya town health institutions, Northeast Ethiopia. Methods: A three years (September 2010 to August 2012) retrospective study was conducted from medical records of 1511 TB patients at Dessie and Woldiya town health institutions. Data were collected using a questionnaire that consists of patients’ age, sex, weight, TB history, TB type, HIV status, availability of supporter, availability of mobile number, drug type and TB treatment outcomes in treatment cards and TB logbook from February, 2013 to April, 2013. Pearson chi-square test and logistic regression were employed for data analysis. Results: From 1511 TB patients, 1,331(88.1%) were successfully treated, 123 (8.1%) died, 45 (3.0%) defaulted and 12 (0.8%) failed from treatment. In terms of TB type, 57.4% were pulmonary TB, 40.5% were extra pulmonary TB and 2.1% were both smear negative pulmonary and extra pulmonary TB. In addition, TB-HIV co-infection rate was 42.9% in 2010, with significant reduction in 2012 (33.7%) (P<0.01). Multivariate logistic regression showed the odds of successful treatment outcome was higher among females (AOR=2.09, 95% CI: 1.27-3.45), new TB patients (AOR=10.52, 95% CI: 3.96-27.93), patients with unknown HIV status (AOR=7.16, 95% CI; 1.56-32.75) and HIV negative (AOR=1.80, 95% CI: 1.09-2.99) when compared with the respective comparison groups. The odds of defaulting was higher among TB patients started treatment in Dessie Health Center (AOR=4.09, 95% CI: 1.33-12.60) and combined smear negative pulmonary and extra pulmonary TB disease (AOR=8.87, 95% CI: 2.53-31.02) compared with the respective comparison groups. Conclusions: Treatment success rate of TB patients in this study was very encouraging for TB control through DOTS strategy. Nevertheless, TB patients with HIV/AIDS, combined smear negative pulmonary and extra pulmonary TB and with previous history of TB were found to be at risk of poor treatment outcome. Correspondingly, male TB patients and those who attend health centers should be encouraged for successful treatment outcome. Generally, to reduce poor treatment outcome, patients should be strictly followed by health extension workers or trained community health workers in Dessie and Woldiya town health institutions.

The effectiveness of educational interventions for health professionals in Direct Observed Therapy and the Directly Observed Therapy Short-Course strategy: a systematic review protocol

Review question/objective What are the most effective educational interventions that are used to improve patients’ outcomes via improvement of health professionals’ knowledge and practice in the Direct Observed Therapy of Tuberculosis and the Directly Observed Therapy Short-Course (DOTS) strategy? Inclusion criteria Types of participants All categories of health professionals directly involved in Direct Observed Therapy of Tuberculosis (DOT) and Directly Observed Therapy Short-Course (the overall DOTS strategy), working either in hospital settings, the public health field or other health sectors. Types of interventions This review will consider studies that evaluate educational interventions used by health institutions or health authorities in order to improve patients’ health by enhancing the knowledge and practice of health professionals regarding the DOTS strategy and DOT (supervised therapy/treatment of Tuberculosis). The educational interventions can be compared to another type of educational intervention, or to no education. Types of outcomes Educational knowledge and practice outcomes are intermediary outcomes, but the main outcomes of interest are patient-related outcomes. The primary outcome of interest for this review is the number of TB cases (smear positive TB patients) detected by the health professionals. Secondary outcomes of interest for this review are: Compliance as measured by counting the number of patients completing TB treatment; Dropout attrition rates as measured by counting the number of patients who did not complete the treatment or who abandoned the treatment at some point; Cured from TB as confirmed by Bacilloscopy, X-ray or culture and sensitivity tests that may or may not include an additional assessment of the patients for clinical signs and symptoms; and All-cause mortality and mortality due to TB.

La estrategia DOTS, en búsqueda de la cura para la tuberculosis

Introducción: en la actualidad, la tuberculosis es considerada un problema mundial de salud pública de grave magnitud que requiere atención urgente y causa considerables costos directos e indirectos a los individuos y la sociedad. Directly Observed Therapy-Short Course (DOTS) es una estrategia acortada supervisada para el tratamiento de la tuberculosis, cuyo fin es asegurar la curación de la enfermedad. Objetivo: Determinar los conceptos y elementos claves que integran la estrategia DOTS en el tratamiento de la tuberculosis. Metodología: se hizo una revisión de la literatura en las bases de datos PubMed y Lilacs, empleando los términos: DOTS y tuberculosis. Se incluyeron todos los artículos de revisión en inglés y español con acceso gratuito que incluyeran un abordaje integral a dicha estrategia. Resultados: para el año 2000, 148 países habían adoptado la estrategia DOTS de la OMS para el control de la TB y un 27% de los casos mundiales de TB fueron tratados bajo esta. Aunque apreciable, este progreso no ha sido suficiente. Debido a problemas con los recursos humanos, recortes financieros, infraestructura inadecuada para la atención en salud y falta de abastecimiento seguro de fármacos antituberculosos de buena calidad, la estrategia DOTS no ha logrado un rápido crecimiento. Conclusiones: DOTS es una estrategia adecuada para asegurar la curación de la tuberculosis; sin embargo, son necesarias mayores inversiones económicas que busquen la prevención y adecuado control de esta enfermedad. [Cardona J, Jiménez E, Mejía L. La estrategia Directly Observe Therapy ShortCourse (DOTS), en búsqueda de la cura para la tuberculosis. MedUNAB 2014;16(3):143-148]

Treatment of Childhood Tuberculosis

The aim of tuberculosis treatment is to cure the individual patient with antituberculosis drugs (ATT) in a short time without emergence of drug resistance. The anti tuberculosis drugs are selected in a combination to attack all the subpopulations of tubercle bacilli with first line drugs which include isoniazid, rifampicin, pyrazinamide, and ethambutol. Intermittent ATT regimens have been documented to be as effective as daily regimen. World Health Organization (WHO) has suggested a category based treatment of tuberculosis given in two phases, intensive phase and continuation phase. As per WHO, Revised National Tuberculosis Control Programme (RNTCP) recommends directly observed therapy short course strategy (DOTS) for the treatment of both adult and pediatric tuberculosis. In DOTS the patient is asked to swallow ATT under the direct observation of health personnel. Drug dosage for daily and intermittent therapy varies. To simplify the prescription, fixed drug combination (FDC) and patient-wise boxes (PWB) are available under RNTCP, free of cost. Each patient's management plan should be individualized to incorporate measures that facilitate adherence. The knowledge of drug resistant tuberculosis, HIV-related tuberculosis, and latent tuberculosis infection are the areas that need to be updated. Private practioners may play a significant role by referring the children with tuberculosis to the DOTS centers early which will not only benefit the affected family but also the society.

Role of 2-month sputum smears in predicting culture conversion in pulmonary tuberculosis

Sputum smears and culture conversion are frequently used to evaluate treatment response in pulmonary tuberculosis patients. Limited data are available on the evaluation of the correlation between under-treatment sputum smear results and culture conversion. This prospective study included sputum culture-proven pulmonary tuberculosis patients at six hospitals in Taiwan. At least two sets of sputum were collected at the completion of 8 weeks of TB treatment. The sensitivities and specificities of 2-month sputum smears were estimated based on culture conversion status. A total of 371 patients were enrolled for analysis. Factors associated with culture conversion included having a smear positive before treatment, presence of a cavity on radiography, rifampicin resistance and usage of the DOTS (directly observed therapy, short course) strategy. The sensitivities of 2-month sputum smears for culture conversion among all patients, initially smear-positive patients and initially smear-negative patients were 64.3, 71.4 and 38%, respectively, and the specificities were 81.6, 69.9 and 92.8%, respectively. In patients who were 2-month sputum smear-positive, the 2-month culture conversion rate was 80% if the patients were under DOTS and without cavitary lesions in radiograms. The predictive value of 2-month sputum smears in culture conversion was limited and highly influenced by clinical factors in pulmonary tuberculosis patients.

Characterization and evaluation of the directly observed treatment for tuberculosis in Santiago de Compostela (1996-2006).

To realize a retrospective study of the characterization, results, and effectiveness of directly observed therapy, short course (DOTS) in the regional health area of Santiago de Compostela (population 453 068) between 1996 and 2006. Tuberculosis (TB) patient cases involved in DOTS treatment were reviewed. The studied variables included: age, sex, type of TB, TB location, microbiological studies, chest radiology, pattern and treatment duration, final status of case, and TB recurrence. There were 2456 diagnosed TB cases in the time period studied and 259 received DOTS. The reasons for inclusion in this treatment strategy were social dystocia in 33.2% of cases, retreatment in 30.8% of cases, alcoholism in 29.3% of cases, drug use in 17.4% of cases, HIV coinfection in 11.6% of cases, multidrug-resistant strains of TB (MDR-TB) in 3.1%, and being an immigrant in 1.9% of cases. Primary TB represented 3.5% of the instances and pulmonary TB represented 87.6%. Bacteriological confirmation was performed in 76.8% of this population. Cavitated forms in chest radiology were shown in 46.7% of patients. Standard treatment guidelines were used in 71.4% of patients. Treatment adherence was achieved in 96.1% of the cases and 86.9% cases had a successful final status. Recurrence of TB was 1.5%. Although it is not possible to determine the exact influence of the DOTS strategy, its introduction under the conditions of the Galician Program for Prevention and Control of Tuberculosis (GPPCT)5 has worked to improve the control of tuberculosis in our health area.

General physicians' knowledge of tuberculosis control and treatment with DOTS strategy

Purpose: Turberculosis has a long history and it is still fatal in the third millennium. Since 1993, the Directly Observed Therapy Short-Course (DOTS) strategy has been approved by the WHO as a global strategy for tuberculosis treatment and control. This research was undertaken to assess the general physicians' (GPs) knowledge of tuberculosis control and treatment using DOTS strategy and to evaluate the necessity for its insertion in the medical schools' curriculum. Material & Method: 1500 questionnaires were distributed to GPs at national conferences and continuing medical education sessions in tuberculosis and infections diseases. The questionnaires included questions about demographic information, general knowledge about DOTS, implementation of DOTS and problems related to its implementation. All data, were analyzed with an SPSS package, using the Chi-square rest. Findings: Out of the 486 GPs who responded to the questionnaires, 34.5% knew what DOTS stood for, and 43.8% were familiar with the definition of DOTS. In clinical teaching course, 10.2% had become familiar with DOTS in medical schools and 56.6%, through the health care system. 69% of the trained GPs and 14% of the untrained GPs answered the questions correctly. (P=0.001). about 21% of the GPs were involved in the implementation of DOTS. Among the GPS who were involved in implementing DOTS, 82% gave correct answers. From among the GPs who were not involved in implementing DOTS. 33% had correct answers to the questions (P=0.001). Conclusion: According to the results of this research, GPs have little knowledge of GPs strategy. Its entry into the medical curriculum is therefore essential. Key words: DOTS, TUBERCULOSIS CONTROL, GPs ' KNOWLDEDGE

Treatment Outcomes in Culture-Positive Pulmonary Tuberculosis

The aim of the study was to evaluate treatment outcomes in sputum culture positive patients with tuberculosis in three Polish provinces (Warsaw, Gdansk and Siedlce Provinces) in 1995 and again in 2000. We also assessed whether the implementation of the Directly Observed Therapy Short Course (DOTS) strategy in the former Gdansk Province led to improved outcomes compared to the outcomes observed in 1995, when this strategy was not being followed. We started the study by reviewing microbiology registers covering the years 1995 and 2000 from all the tuberculosis laboratories in three provinces (Warsaw, Gdansk and Siedlce Provinces) and identified sputum culture positive patients. We then reviewed inpatient and outpatient medical records of patients who had been with pulmonary tuberculosis diagnosed and confirmed by bacteriology in 1995 and 2000. Treatment outcomes were evaluated in accordance with the World Health Organisation (WHO) recommendations and classified as: cure, treatment completed, default, treatment failure, death or other. A total of 708 patients were included in the study: 373 diagnosed in 1995 and 335 diagnosed in 2000. According to the WHO criteria, the treatment success rate (the sum of cures and treatment completions) in 1995 and 2000 was 58.8% and 54.0%, the default rate was 15.5% and 17.9%, the failure rate was 2.4% and 2.7% and the death rate was 5.6% and 6.3%, respectively. The rate of outcomes classified as "other" was 18.2% and 22.1%, respectively. Following the implementation of the DOTS strategy in Gdansk Province, treatment outcomes in significantly improved in 2000 compared to the year 1995. The treatment success rate was 89.6% vs 69.3% (p = 0.0037), the default rate was 0.0% vs. 14.7% (p = 0.0005) and the death rate was 0.0% vs. 9.3% (p = 0.0184). The treatment success rate (the rate of cures and treatment completers) in 1995 and 2000 was 58.8% and 54.0% and was lower than that recommended by WHO (at least 85%). The results demonstrated that the treatment outcomes in the former Gdansk Province in 2000, following the implementation of the DOTS strategy, were significantly better than those in 1995, when the strategy was not being followed. Treatment success was observed in 89.6% and 69.3% of the patients, respectively (p = 0.0037).

Impact of lifestyle on tuberculosis

Abstract: Tuberculosis (TB) is well known to be associated with poverty and multiple social factors. However, relatively little attention has been paid to the behavioural factors, apart from those associated with drug abuse, alcoholism and HIV infection. In recent years, the roles of other lifestyle‐related factors have been increasingly recognized. In particular, smoking has been associated with excess risks of TB infection, disease and mortality. Only limited evidence is available for the association between TB disease and passive smoking or the use of biomass fuels. Nutrition status also plays an important role. Malnutrition or underweight is associated with increased risk of TB disease, and obesity appears to be protective. On the other hand, diabetes mellitus increases the risk of TB disease, but mainly among those with poor diabetic control. Although the increase in TB risk is only modest for most lifestyle factors, their prevalences are increasing rapidly in some Asian communities. Furthermore, as much as one‐third of the world population is thought to be latently infected with the tubercle bacillus. The successful introduction of directly observed therapy—short course (DOTS) might have rapidly reduced the ongoing risk of transmission in many parts of Asia. However DOTS alone is unlikely to eliminate the continuing emergence of infectious tuberculosis cases through endogenous reactivation among the large pool of latently infected subjects in the Asia–Pacific region. With the close interaction between lifestyle, aging population and aging TB epidemic, promotion of healthy lifestyle may help to complement the DOTS strategy in the control of TB.

More than Ten Years of DOTS in Bosnia and Herzegovina

Directly Observed Therapy Short-course (DOTS) is composed of five distinct elements: political commitment, case detection through quality-assured bacteriology; drug supplies; surveillance and monitoring systems and use of highly efficacious regimens; and direct observation of treatment. DOTS produces cure rates of up to 95 percent even in the poorest countries and prevents the development of Multi-Drug Resistant Tuberculosis. National TB Programme (NTP) has been started to introduce in 1994 according to DOTS principles in B&H with central and regional levels. At central levels there are national TB coordinators, and in all Cantons/Regions there are regional TB Coordinators. During intensive phase of therapy, patients are hospitalized. In the second phase of therapy, patients are treated in anti-tuberculosis dispensaries and some of them by a responsible member of the family (family supervision). There are several weaknesses in implementation of DOTS in B&H: TB case detection was not fully implemented in all medical services. Registration of TB cases in some facilities, there is no official central recommended registry, individual reporting for treatment outcomes and establishing a reliable monitoring and evaluation system. Application for 6 round of The Global Fund to Fight AIDS, TB and Malaria (GFATM) had been finally approved and signed for B&H in October 2007. These grants would repair some implementation gaps and improve DOTS strategy in B&H.

The Vietnamese Khin Population Harbors Particular N-Acetyltransferase 2 Allele Frequencies

Vietnam ranks 13th among the 23 countries that must deal with 80% of global deaths from tuberculosis (1). The National Tuberculosis Control Program of Vietnam implemented the WHO DOTS (directly observed therapy, short course) strategy in 1989. The standard treatment regimen for previously untreated patients consists of 2 months of streptomycin, isoniazid (INH), rifampin, and pyrazinamide, followed by 6 months of INH and ethambutol (the 2SHRZ/6HE regimen). INH, a central component of this chemotherapy, is extensively metabolized by the polymorphic N -acetyltransferase 2 (NAT2) enzyme. N -acetyltransferase 2 (arylamine N -acetyltransferase) ( NAT2 ) gene polymorphisms are associated with individual phenotypes generally classified as INH rapid (homozygous or heterozygous) and slow acetylators. Among the described NAT2 alleles, NAT2*5 , * 6 , * 7 , 12 *, * 14 , * 17 , and * 19 have been associated with the slow acetylator phenotype, and NAT2*4 and * 13 are associated with fast acetylation. Under treatment with standard dosages, patients who are slow metabolizers …

The role of the Brezovik hospital in education of health professionals on the implementation of directly observed treatment strategy

In 2003, the International Union Against Tuberculosis and Lung Disease (IUATLD) reported that tuberculosis is increasing globally more than ever in the history of mankind. Thus, tuberculosis is one of the major health problems of the twenty-first century. Directly Observed Therapy Short-Course (DOTS) is the WHO's strategy for tuberculosis control. All HBCs (Hligh-burden Countries) have a strategic plan for DOTS expansion for the next five years. The DOTS strategy is included in the country's basic package of health-care services. With the introduction of the DOTS strategy in late 1990s, the surveillance was improved, although the 2003 estimate of 53% DOTS coverage is probably optimistic. The Special Hospital for Lung Diseases Brezovik is the main regional hospital for tuberculosis treatment in Montenegro, and the place where the DOTS strategy is being implemented The Special Hospital for Lung Diseases Brezovik plays a very important role in education of health care professionals.

Antituberculosis Drug Resistance in the South of Vietnam: Prevalence and Trends

There is limited evidence that the DOTS (directly observed therapy, short course) strategy for tuberculosis (TB) control can contain the emergence and spread of drug resistance in the absence of second-line treatment. We compared drug-resistance levels between 1996 and 2001 in the south of Vietnam, an area with a well-functioning DOTS program. Sputum specimens were collected from consecutively diagnosed patients with smear-positive TB at 40 randomly selected public TB clinics. Mycobacterium tuberculosis isolates were tested for susceptibility to first-line drugs. Among 888 new patients in 2001, resistance to any drug was observed in 238 (26.3%), resistance to isoniazid was observed in 154 (16.6%), resistance to rifampin was observed in 22 (2.0%), resistance to ethambutol was observed in 12 (1.1%), resistance to streptomycin was observed in 173 (19.4%), and resistance to both isoniazid and rifampicin (multidrug resistance [MDR]) was observed in 20 (1.8% [95% confidence interval, 1.0%-3.3%]). Among 136 previously treated patients in 2001, any resistance was observed in 89 (62.9%), and MDR was observed in 35 (23.2%). The prevalence of any drug resistance and of streptomycin resistance among new patients had decreased significantly (P<.01) since 1996; there was no increase in the prevalence of MDR. The prevalence of drug resistance decreased despite high initial levels of resistance to isoniazid and streptomycin and despite the absence of second-line treatment. Therefore, a DOTS program can contain drug-resistant TB in this setting.