|SHORT COURSE CHEMOTHERAPY OF TUBERCULOSIS PROCEDURAL
STRATEGIES IN DISTRICT TUBERCULOSIS-PROGRAMME
|P Jagota: NTI Newsletter 1982, 19, 95-102.
In the wake of implementation of Short Course Chemotherapy
(SCC) in the programme, some of the organizational aspects of SCC
as observed in a clinical trial at the Lady Willingdon State TB
Centre (LWSTC), Bangalore vis-a-vis to those recommended in the
programme were evaluated. The efficacy of 3 SCC regimens of 3-5
months duration under clinical trial were studied among 381 patients.
The efforts and the resources employed to achieve the results in
the trial are compared with that of those recommended in the District
TB Programme (DTP).
It is observed that there is a wide gap between
the clinical trial and the programme in organisational
efforts and resources. Although the trials cannot act as a model,
if benefits associated with the SCC are to be availed, extra staff
and transport for home visiting should be provided. The aspects
of the organisation which need strengthening are motivation, timely
defaulter action (preferably on the same day mainly as home visit)
and efficient management of large number of patients attending the
clinic for supervised drug administration, adverse reaction etc.,
before recommending the use of SCC in the DTP.
|KEY WORDS: SCC, CONTROL PROGRAMME, CLINICAL
|ORGANIZATIONAL EFFORT IN A CLINICAL TRIAL AND ITS
RELEVANCE TO APPLICABILITY OF SHORT-COURSE CHEMOTHERAPY IN NATIONAL
|KS Aneja & GE Rupert Samuel: Indian J TB 1982,
The high rate of treatment completion and the regularity
of drug intake achieved in clinical trials of Short Course Chemotherapy
(SCC), could possibly be attributed to efficient organizational
set-up, careful selection of cases and all-out effort to control
defaulters. The organizational effort put forth to achieve the regularity
is relevant to the applicability of SCC in the existing set-up of
District Tuberculosis Centres (DTCs) under National Tuberculosis
Programme (NTP). First 300 patients admitted to SCC trial to assess
the efficacy of three drug regimens of 3/5 months duration under
fully supervised conditions, carried out jointly by National Tuberculosis
Research Centre, Madras and National Tuberculosis Institute (NTI),
Bangalore, have been analysed for the purpose.
To keep up the regularity, 1/3rd of the patients
required home visits-some of them repeatedly. If the actions of
the same intensity of defaulter retrieval in the form of home visiting
are envisaged to be taken in a DTC with the normal working pattern
catering to 500 patients, 250 to 300 home visits will have to be
made in a month. This may not be feasible in the existing set-up
of NTP. A new strategy of defaulter retrieval actions for programme
conditions may have to be devised. Further, selection of drug regimen
which has the maximum potential of being given on self-administered
basis may reduce the work-load to a considerable extent. Drug toxicity,
side effects and the cost of drugs may not be major handicaps. However,
the only way to understand various operational problems is to undertake
scientific operational studies in actual working conditions of NTP.
|KEY WORDS: SCC, APPLICABILITY, CLINICAL TRIAL,
COMPLIANCE, CONTROL PROGRAMME.
|A STUDY OF OPERATIONAL FACTORS INFLUENCING THE APPLICABILITY
OF TWO REGIMENS OF SHORT COURSE CHEMOTHERAPY UNDER CONDITIONS OF AN
URBAN TUBERCULOSIS PROGRAMME
|P Jagota, Sudha Xirasagar, N Parimala & K Chaudhuri:
Indian J TB 1989, 36, 213-23.
An operational study of two regimens of Short Course
Chemotherapy (SCC) to assess their efficacy under programme conditions,
applicability and feasibility in District TB Programme (DTP) was
undertaken in an urban TB centre. The two regimens studied were
1SHRZ/7TH and 2SHR/6TH. Their operational efficacy (efficiency)
was found to be 87% and 92% respectively which had already been
reported in an earlier paper. The various factors i.e., initial
willingness, drug default, treatment completion pattern, adverse
drug reactions and initial drug resistance with their potential
harmful effects on the treatment outcome as well as work load and
extra cost these regimens entail for DTP organisation are discussed
in this paper.
Out of a total of 1822 smear positive patients
diagnosed at the Lady Willingdon State TB Centre during intake period
(Feb '84 to March '85), 1126 were residents of Bangalore City. Of
these 695 (61.7%) were unwilling to attend the clinic daily for
2 months, 27 were unfit and one was excluded by mistake. Thus, 403
(38.3%) initially willing patients were classified either as 'core
group' or 'Non core group, according to the history of previous
anti TB treatment (321 and 82 respectively). Of the 695 (77.6%)
unwilling persons, majority were those who pleaded inability to
attend daily for 2 months without specifying any particular reason.
Refusal of SCC due to injections accounted for 12.8% and 9.5% wanted
to take treatment elsewhere. Old age influenced willingness adversely.
Of the 321 patients in the core group, 56 were
excluded due to missing more than 50% of intensive phase doses.
Among the remaining patients, 61 (48%) out of 127 patients on Regimen
A and 48 (34%) out of 138 on Regimen B, did not make a single default
in the intensive phase. Of the total 910 defaults for which actions
were taken, 640 (70%) were retrieved by letter writing,
among the remaining 293 (72%) were retrieved by home visiting.
Main reasons for default elicited during home visits were: going
out of station (52.9%) followed by patients being busy with work
(19.1%). Compensatory phase was availed by 156 of the 265 patients
who missed one or more doses due to default in the treatment. The
pattern of treatment completion of 321 core group patients in the
two regimens were similar i.e., in both the phases 65% for Regimen
A and 63% for Regimen B. Incidence of minor adverse reactions was
28% and major toxic reactions were experienced by 8.4% of patients.
Workload for treating 321 patients was due to supervised administration
of drug 45 patients per day. Letter writing to 3.1 per patients,
home visiting 1.1 per patient and doctor's attention for adverse
reaction 2 occasions per patient. This could be managed with the
existing staff. The cost of Regimen A was Rs.220/ per patient and
for Regimen B, 268/ per patient. Cost to patient for transportation
was Rs.70/ and Rs.113/ for Regimen A and B respectively.The major
disturbing finding of the study was initial low acceptability of
about 40% for SCC. The home visiting which was crucial in increasing
the completion rate in this study is usually not available in most
of the DTCs. Workload, adverse reactions etc. were not of any problem
for implementation of SCC in the programme.
|KEY WORDS: SCC, DAILY REGIMEN, OPERATIONAL FACTORS,
APPLICABILITY, CONTROL PROGRAMME.
|THE FATE OF RESISTANT CASES TREATED WITH THREE DIFFERENT
DRUG REGIMENS OF SHORT COURSE CHEMOTHERAPY UNDER PROGRAMME CONDITIONS
|P Jagota, TR Sreenivas, N Parimala & K Chaudhuri:
Indian J TB 1990, 37, 83-87.
The fate of patients with isoniazid (H) resistant
pulmonary tuberculosis, treated with 3 different Short Course Chemotherapy
regimens (Regimen A-1 SHRZ/7TH, Regimen B-2SHR/6TH, Regimen C-2EHR/4H2R2)
was examined in two sequential studies. One hundred H resistant
patients belonging to two groups-one without history of previous
treatment(core group) and second with history of previous treatment
>=15 days (non-core group), were followed up at the end of 12th,
15th and 24th/36th month of chemotherapy. Bacteriological favourable
response among patients in the core group at the end of chemotherapy
with Regimen A, B and C were 65.2% of 23 patients, 50% of l8 patients,
and 57.1% of 18 patients respectively. The response among patients
in the non-core group were 27.3% with Regimen A and 52.6% with Regimen
At the end of 24/36th month of chemotherapy, 62.5%
patients in the core group and 2 out of 7 in the non-core group
on regimen A and 68.7% patients on regimen C in the core group and
5 out of 15 in the core group and 41.7% in the non-core group on
regimen B were culture negative. The relapses were significantly
high in regimen B & C in comparison with regimen A. Thus, of
the total 100 patients, 99.3% were eligible for examination (1 died
during chemotherapy), 67 were examined and of them 37 (62.7%) were
culture negative, 22 positive and 8 were dead. The development of
drug resistance to rifampicin was directly related to the duration
of its use.
|KEY WORDS: SCC, DRUG RESISTANCE, EFFICACY, CONTROL
|IMPACT OF SHORT COURSE CHEMOTHERAPY ON THE OPERATIONAL
EFFICIENCY OF NATIONAL TUBERCULOSIS PROGRAMME
|TR Sreenivas, CV Shyamasundara, K Chaudhuri: Indian
J TB 1992, 39, 107-11.
Five districts in which short course chemotherapy
(SCC) was introduced during 1987-88 (DTP-SCC) and an equal number
of districts without an SCC programme (DTP-SR) but having comparable
new sputum examinations performance (NSE) in 1986 were selected
from the states of Gujarat and Tamilnadu. Data obtained by the monitoring
cell of the National Tuberculosis Institute (NTI) for 15 consecutive
quarters from the lst quarter of 1986 were analysed. It was possible
to study operational variables: NSE, number of pulmonary patients
diagnosed (TBP) and number of bacillary cases detected (BCASE).
While the figures of first six quarters were used to represent pre
SCC performance, those of the last six quarters depicted the post
SCC scenario. However, the trend analysis has been done using the
The growth rates of NSE, TBP and BCASE were 14.1%,
1.7% and 13.0% respectively for DTP-SCC compared with 17.0%, 5.3%
and 29% for DTP-SR. Both the DTCs and PHIs in DTP-SR showed negative
growth in BCASE, inspite of their efforts as evidenced by increase
in NSE and TBP, the introduction of SCC led to an increase in BCASE
for both DTC and PHIs. While the PHIs in DTP-SCC showed increased
efficiency in all the aspects (NSE 24.4%, TBP 19%, BCASE 16.7%),
DTCs showed decreased activity in NSE ( -2.4) and TBP (-6.6%), indicating
improvement at the periphery. Trend analysis corroborated the above
|KEY WORDS: SCC, IMPACT, OPERATIONAL EFFICACY,
|RESULTS OF TREATMENT WITH A SHORT COURSE CHEMOTHERAPY
REGIMEN USED UNDER FIELD CONDITIONS IN DISTRICT TUBERCULOSIS PROGRAMME
|K Chaudhuri, P Jagota & N Parimala: Indian J
TB 1993, 40, 83-89.
The treatment results of an unsupervised Short
Course Chemotherapy (SCC) regimen used under conditions of District
Tuberculosis Programme (DTP) are presented. The District Tuberculosis
Centre (DTC), Kolar and six of its Peripheral Health Institutions
(PHIs) formed the study area. No extra efforts except ensuring of
adequate availability of drugs at the participating centres were
made to obtain patients' compliance. In all, 584 smear positive
tuberculosis patients were diagnosed during the study period but
28.3% of the patients could not be initiated on treatment with the
chosen self administered SCC regimen -2EHRZ/6TH(EH).
Of the 382 put on treatment, only 33.2% completed
over 75% drug collections in both intensive and continuation phases.
The pattern of treatment compliance did not vary with the place
of treatment, i.e. DTC or PHI. Irrespective of treatment compliance,
nearly 72-77% of the patients attained smear negative status at
the end of the period of treatment, there being no difference between
PHI and DTC. However, deaths were higher in the PHI patients. This
could be attributed to a significantly higher proportion of aged
patients taking treatment at PHI than at DTC. Considering death
as an unfavourable outcome, overall favourable response was 65.9%.
Patients with drug sensitive bacilli had a higher rate of culture
negativity (70%), as compared to those with drug resistant bacilli
(48%). It was concluded that unsupervised SCC could give encouraging
results in a DTP setting, provided adequate drug supply was ensured.
|KEY WORDS: SCC, CONTROL PROGRAMME, OPERATIONAL