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.