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Introduction
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Revised
National TB Control Programme and DOTS
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In 1962,
India introduced its National Tuberculosis
Programme (NTP) for the first time to bring the
problem of tuberculosis under control.
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In 1992,
the NTP was reviewed by a group of national and
international experts to correct the flaws of NTP
and to assess the current situation. The new
programme was called the Revised National
Tuberculosis Control Programme (RNTCP).
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DOTS
(Directly Observed
Treatment, Short Course) was the strategy adopted in
this new programme (RNTCP).
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In
DOTS strategy, the TB patient is given all his
medicines free of cost under the supervision of a
health worker.
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The key
role in the DOTS treatment is that of the health
worker, who is responsible for institution of
observed treatment to patients.
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DOTS
therapy is an intermittent type of therapy where the
anti-TB drugs are taken on alternate days of the
week for the entire duration of the
therapy (6 - 8 months).
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DOTS has
five components :
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Diagnosis
by sputum examination.
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Regular
supply of drugs is ensured.
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Directly
observed treatment is provided by the health
workers.
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Evaluation
and monitoring of the programme is done to see
the success rate in terms of patients cured.
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Political
(government) commitment.
Treatment
under DOTS :
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The
patient takes medication under the direct
supervision of a health worker where the
worker ensures that the patient swallows his
medicines.
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In the intensive
phase the patient comes regularly (thrice
weekly) to the DOTS centre to take medicines under
supervision.
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In the continuation
phase the patient is issued medicines for one
week, of which one dose is taken in front of the
health worker. In the following week, the patient is
again issued medicines only after he returns the
empty blister pack of the previous week's medicines.
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Sputum
examination is done at regular intervals and at the
end of the treatment to judge the course of disease.
- DOTS is the
best method to ensure that the patients are taking
drugs regularly.
- DOTS
ensures :
- Treatment with
the right drugs.
- In the right
dose.
- At the right
interval.
- Advantages
of DOTS :
- High cure rates.
- Good patient
compliance.
- Defaulters can
be easily tracked and brought back for
treatment.
- Decreases risk
of emergence of drug resistant TB.
- Decreases risk
of close contacts getting TB (as DOTS helps in
rapid elimination of infection).
- Free TB drugs to
all the patients (thus ensuring
non-interruption of the treatment
because of economic constraints).
- The WHO has
categorized patients with tuberculosis as
:
| TB
treatment category |
TB
Patients |
| Category
I |
- New smear
positive pulmonary TB.
- New smear -
negative pulmonary TB with extensive lung
involvement.
- New cases of
severe forms of Extra-Pulmonary TB. e.g.
Meningitis, Spinal TB, Heart TB,
Intestinal TB, etc.
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| Category
II |
- Relapse
cases.
- Treatment
failure cases.
- Patients
interrupting treatment (Defaulters).
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| Category
III |
- New smear -
negative pulmonary TB.
- New less
severe forms of Extra-Pulmonary TB. e.g.
TB lymph nodes, bone TB, etc.
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Treatment
Regimens under RNTCP (DOTS)
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Patient category
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Intensive
phase |
Continuation
phase |
Category I
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2
(RHZE)3 |
4(RH)3 |
Category II
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2
(SRHZE)3 / 1 (RHZE)3 |
5
(RHE)3 |
Category III
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2(RHZ)3 |
4(RH)3 |
NOTE :
The entire country will come under this programme in
the near future because of the vigorous efforts of WHO
and the government of India.
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