||Jochem K, Fryatt RJ, Harper I, White A, Luitel H &
||Tuberculosis control in remote districts of Nepal comparing
patient-responsible short-course chemotherapy with long-course treatment
||INT J TB & LUNG DIS 1997, 1, 502-08
This study was conducted to evaluate the effectiveness
of unsupervised monthly-monitored treatment using an oral short-course
regimen in hill and mountain districts of Nepal supported by an
international NGO. In this prospective cohort study, outcomes for
new cases of smear-positive TB starting treatment over a two year
period in four districts in which a 6 month rifampicin containing
regimen was introduced as first line treatment (subjects) were compared
to outcomes for similarly defined cases in four districts where
a 12 month regimen with daily streptomycin injections in the intensive
phase continued to be used (controls).
Of 359 subjects started on the 6 month regimen,
85.2% completed an initial course of treatment compared to 62.8%
of 304 controls started on the 12 month regimen (P < 0.001);
78.8% of subjects and 51.0% of controls were confirmed smear-negative
at the end of treatment (P < 0.001). The case fatality rate during
treatment was 5.0% among subjects and 11.2% among controls (P=0.003).
Among those whose status was known at two years, 76.9% of subjects
were smear negative without retreatment, compared to 60.9% of controls
(P < 0.001).
In an NGO supported TB control programme in remote
districts of Nepal, patient responsible short course therapy supported
by rapid tracing of defaulters achieved acceptable outcomes. Where
access and health care infrastructure are poor, district-level TB
teams responsible for treatment planning, drug delivery and programme
monitoring can be an appropriate service model.
|KEY WORDS: PATIENT RESPONSIBLE THERAPY; COMPLIANCE;