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.
  • 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).
  • DOTS (Directly Observed Treatment, Short Course) was the strategy adopted in this new programme (RNTCP).
  • In DOTS strategy, the TB patient is given all his medicines free of cost under the supervision of a health worker. 
  • The key role in the DOTS treatment is that of the health worker, who is responsible for institution of observed treatment to patients.
  • 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).
  • DOTS has five components :
    • Diagnosis by sputum examination.
    • Regular supply of drugs is ensured.
    • Directly observed treatment is provided by the health workers.
    • Evaluation and monitoring of the programme is done to see the success rate in terms of patients cured.
    • Political (government) commitment.

Treatment under DOTS :

  • The patient takes medication  under the direct supervision of a health worker where the worker ensures that the patient swallows his medicines.
  • In the intensive phase the patient comes regularly (thrice weekly) to the DOTS centre to take medicines under supervision.
  • 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.
  • 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.
 Category II
  • Relapse cases.
  • Treatment failure cases.
  • Patients interrupting treatment (Defaulters).
 Category III
  • New smear – negative pulmonary TB.
  • New less severe forms of Extra-Pulmonary TB. e.g. TB lymph nodes, bone TB, etc.

 

Treatment Regimens under RNTCP (DOTS)
Patient category Intensive phase Continuation phase
 Category I 2 (RHZE)3 4(RH)3
 Category II 2 (SRHZE)3 / 1 (RHZE)3 5 (RHE)3
 Category III 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.