BACKGROUND: India is initiating the DOTS-Plus strategy at the national level. OBJECTIVES: To highlight the results, constraints and issues of a pilot DOTS-Plus experience in an urban setting in India. METHODS: Records of 126 patients with multidrug-resistant tuberculosis (MDR-TB) enrolled from January 2002 to December 2006, who received a daily fully supervised standardised treatment regimen under a pilot DOTS-Plus study in India, were analysed retrospectively. RESULTS: Of the 126 patients enrolled, 61% were cured, 19% died, 18% defaulted and 3% failed treatment. There was an average delay of 5 months in the diagnosis of MDR-TB and a subsequent delay of approximately 3.3 months in initiating treatment. Of the 24 patients who died, 29% did so within a month of starting treatment. Migration was the most common reason for default. Cycloserine (CYC) had to be stopped in 15 patients and kanamycin (KM) in five due to major adverse effects. CONCLUSIONS: The DOTS-Plus programme in resource-poor settings may provide reasonable results; however, it may confront significant operational difficulties in the timely diagnosis and early initiation of treatment. Early diagnosis and start of treatment may prevent some deaths. Default is commonly due to migration. CYC proved to be the most toxic drug, followed by KM.
BACKGROUND: India is initiating the DOTS-Plus strategy at the national level. OBJECTIVES: To highlight the results, constraints and issues of a pilot DOTS-Plus experience in an urban setting in India. METHODS: Records of 126 patients with multidrug-resistant tuberculosis (MDR-TB) enrolled from January 2002 to December 2006, who received a daily fully supervised standardised treatment regimen under a pilot DOTS-Plus study in India, were analysed retrospectively. RESULTS: Of the 126 patients enrolled, 61% were cured, 19% died, 18% defaulted and 3% failed treatment. There was an average delay of 5 months in the diagnosis of MDR-TB and a subsequent delay of approximately 3.3 months in initiating treatment. Of the 24 patients who died, 29% did so within a month of starting treatment. Migration was the most common reason for default. Cycloserine (CYC) had to be stopped in 15 patients and kanamycin (KM) in five due to major adverse effects. CONCLUSIONS: The DOTS-Plus programme in resource-poor settings may provide reasonable results; however, it may confront significant operational difficulties in the timely diagnosis and early initiation of treatment. Early diagnosis and start of treatment may prevent some deaths. Default is commonly due to migration. CYC proved to be the most toxic drug, followed by KM.
Authors: Paul H Park; Cornelius Magut; Adrian Gardner; Dennis O O'yiengo; Lydia Kamle; Bernard K Langat; Nathan G Buziba; E Jane Carter Journal: Trop Med Int Health Date: 2011-12-05 Impact factor: 2.622
Authors: Petros Isaakidis; Helen S Cox; Bhanumati Varghese; Chiara Montaldo; Esdras Da Silva; Homa Mansoor; Joanna Ladomirska; Giovanni Sotgiu; Giovanni B Migliori; Emanuele Pontali; Peter Saranchuk; Camilla Rodrigues; Tony Reid Journal: PLoS One Date: 2011-12-01 Impact factor: 3.240
Authors: Petros Isaakidis; Bhanumati Varghese; Homa Mansoor; Helen S Cox; Joanna Ladomirska; Peter Saranchuk; Esdras Da Silva; Samsuddin Khan; Roma Paryani; Zarir Udwadia; Giovanni Battista Migliori; Giovanni Sotgiu; Tony Reid Journal: PLoS One Date: 2012-07-11 Impact factor: 3.240