Ananya Prabhu1, Upasna Agarwal2, Jaya Prasad Tripathy3, Neeta Singla2, Karuna Sagili4, Pruthu Thekkur5, Rohit Sarin2. 1. National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India. Electronic address: prabhuananya@gmail.com. 2. National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India. 3. Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India. 4. The Union South East Asia Office, New Delhi, India. 5. The Union South East Asia Office, New Delhi, India; Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.
Abstract
BACKGROUND: In India, daily regimen with fixed-dose combination along with 99DOTS adherence tool and one-stop service at Anti-Retroviral Treatment (ART) centres for HIV infected Tuberculosis (TB) patients was launched in 2017. No systematic evaluation of its implementation has been done so far in a tertiary care setting in urban India. METHODS: A mixed-methods study was conducted at National Institute of Tuberculosis and Respiratory Diseases, Delhi in 2018-19. Missed doses, average adherence and treatment outcomes were compared across 99DOTS dashboard and TB treatment card. In-depth interviews of patients and health care providers were conducted to explore the implementation challenges and benefits. RESULTS: Median of missed doses recorded during intensive and continuation phase were 56 and 68 respectively in 99DOTS as compared to 0 in the TB Treatment card (p<0.0001). Average adherence was observed to be 27% in 99DOTS versus 99% in the TB treatment card (p<0.0001). Technical issues like software malfunction, logistic difficulties such as missing custom envelops and patient's inability to give call were reported. Role clarity among ART and TB program staff was ambiguous, which contributed to poor information flow between them. Patient benefits such as reduced stigma, less travel costs and reduced work absenteeism were reported. CONCLUSION: Success of 99DOTS program under programmatic condition needs webtool stability, uninterrupted logistic supplies (envelops), training of staff and better coordination between TB and HIV program personnel. Despite the challenges in its implementation, the benefit of this tool in terms of greater convenience and reduced stigma for patients is encouraging.
BACKGROUND: In India, daily regimen with fixed-dose combination along with 99DOTS adherence tool and one-stop service at Anti-Retroviral Treatment (ART) centres for HIV infected Tuberculosis (TB) patients was launched in 2017. No systematic evaluation of its implementation has been done so far in a tertiary care setting in urban India. METHODS: A mixed-methods study was conducted at National Institute of Tuberculosis and Respiratory Diseases, Delhi in 2018-19. Missed doses, average adherence and treatment outcomes were compared across 99DOTS dashboard and TB treatment card. In-depth interviews of patients and health care providers were conducted to explore the implementation challenges and benefits. RESULTS: Median of missed doses recorded during intensive and continuation phase were 56 and 68 respectively in 99DOTS as compared to 0 in the TB Treatment card (p<0.0001). Average adherence was observed to be 27% in 99DOTS versus 99% in the TB treatment card (p<0.0001). Technical issues like software malfunction, logistic difficulties such as missing custom envelops and patient's inability to give call were reported. Role clarity among ART and TB program staff was ambiguous, which contributed to poor information flow between them. Patient benefits such as reduced stigma, less travel costs and reduced work absenteeism were reported. CONCLUSION: Success of 99DOTS program under programmatic condition needs webtool stability, uninterrupted logistic supplies (envelops), training of staff and better coordination between TB and HIV program personnel. Despite the challenges in its implementation, the benefit of this tool in terms of greater convenience and reduced stigma for patients is encouraging.
Authors: Tsegahun Manyazewal; Yimtubezinash Woldeamanuel; David P Holland; Abebaw Fekadu; Vincent C Marconi Journal: BMC Med Date: 2022-09-28 Impact factor: 11.150
Authors: Elizabeth J Ragan; Christopher J Gill; Matthew Banos; Tara C Bouton; Jennifer Rooney; Charles R Horsburgh; Robin M Warren; Bronwyn Myers; Karen R Jacobson Journal: JMIR Res Protoc Date: 2021-06-16