To identify the causes of default under DOTS & develop preventive strategies to ensure compliance.METHOD: 300 patients under DOTS at various Treatment Centres 2 months were recruited prospectively. After[tmsnew]63[/tmsnew](TC) reported after defaulting for complete evaluation & symptomatic treatment, they were administered on DOTS as per protocol or on revised treatment.
Demographic profile revealed: 21-40 years age group (63%), low socioeconomic background (75%), smoker (61%), alcoholic (24%), illiterate (43%), <40kg body weight group (BWG) (74.6%). Categorywise default - 48.6%(Cat. I), 38.6% (Cat. II) & 12.6% (Cat. III). Patients related causes of defaults - symptomatic benefit (20%), poor or no symptomatic benefit (7.3%), hemoptysis, pneumothorax (8.3%), behavioural (4.6%) & socio-occupational (4.6%). Health care delivery system related causes - distance to TC (8.6%), behaviour of staff (4%) and non-availability of drug (2.6%). Drug related causes - gastric intolerance (24.6%), hapatitis (7.3%) and number of pills (3.3%). Default was multifactorial in 8% cases. Adverse effects of drugs were frequent in lower BWG (78.9% in 40 kg. BWG). After evaluation, steps taken were - symptomatics and continued on DOTS (44.6%), DOTS was resumed after counseling and overcoming administrative problems (39.3%), switched to revised treatment (10% MDR) and failed to resume DOTS because of poor faith (6%). Hence, it was possible to resume DOTS in 83.9% patients while in 15.9% DOTS could not be resumed.
An urgent action must be taken to avoid default from DOTS because most of these are manageable and if ignored can lead to catastrophic consequences.CLINICAL IMPLICATION: Prokinetic agent must be given prior to DOTS to minimise GI side effects. Doses to be modified in lower BWG and spacing may be allowed. Patient’s education, motivation and counseling is must to prevent default after symptomatic benefit. Availability of drugs/staff should be ensured at each TC. All causes of default must be tackled with appropriate measures along with sympathetic attitude.
M. Vats, None.