||Uplekar MW & Sheela Rangan
||Alternative approaches to improve treatment adherence
in tuberculosis control programme.
||INDIAN J TB 1995, 42, 67-74.
Non-adherence to treatment by patients is a major
impediment, worldwide, in controlling TB. Failure of approaches
attempted so far, in effectively tackling the problem of non-adherence,
has led to the inclusion of directly observed or supervised chemotherapy
as an essential element of the WHO's revised strategy for global
TB control. Supervise chemotherapy has also been made the most important
component of India's NTP being revitalized with the help of a loan
from the World Bank and technical assistance from WHO. The reason
for advocating supervised chemotherapy in India is the failure to
ever achieve desirable cure rates, under a well designed NTP in
operation for ever 3 decades. The demonstration projects of several
NGO's, claiming success in achieving high cure rates, rarely provide
hard data as evidence and their results are often considered anecdotal
and unsuitable for wider application. This paper presents alternative
approaches adopted by two NGOs providing services to large
populations in different settings, one a most backward area of rural
Gujarat and the other in the slums of Bombay. Both organizations
could ensure reasonably high levels of treatment completion and
cure rates under field conditions. While the urban NGO used pre-registration
screening and motivation as tools to ensure treatment completion
and cure, the rural NGO successfully employed the services of the
female anganwadi workers of the Integrated Child Development Services(ICDS)
scheme. The reproducibility and wider applicability of some important
elements of these approaches are discussed.
|KEYWORDS: COMPLIANCE; CASE HOLDING; ADHERENCE; INDIA.