Document Detail

Seven-year DOTS-Plus pilot experience in India: results, constraints and issues.
MedLine Citation:
PMID:  19723377     Owner:  NLM     Status:  MEDLINE    
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.
R Singla; R Sarin; U K Khalid; K Mathuria; N Singla; A Jaiswal; M M Puri; P Visalakshi; D Behera
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease     Volume:  13     ISSN:  1027-3719     ISO Abbreviation:  Int. J. Tuberc. Lung Dis.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-09-02     Completed Date:  2009-10-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9706389     Medline TA:  Int J Tuberc Lung Dis     Country:  France    
Other Details:
Languages:  eng     Pagination:  976-81     Citation Subset:  IM    
Department of Tuberculosis and Chest Diseases, Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases, New Delhi, India.
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MeSH Terms
Directly Observed Therapy / methods*,  statistics & numerical data
Middle Aged
Program Development
Retrospective Studies
Treatment Outcome
Tuberculosis, Multidrug-Resistant / prevention & control*
Young Adult

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