Author(s): Sudarshan H, Sridharan VS
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Abstract PIP: According to the Indian National Tuberculosis Program (NTP), only 30\% of tuberculosis (TB) patients receiving conventional treatment and 52\% of those receiving short-course chemotherapy (SCC) complete the treatment. Incompletely cured patients return to the community, and each sputum-positive case can infect 10-14 people in the course of a year. Direct monitoring of chemotherapy is a must for success, especially if rifampicin is used after accurate diagnosis based on bacteriological examination. The National Leprosy Eradication Program, which has involved voluntary organizations, provides an example to be followed by NTP. This example was considered when the Karuna Trust, a voluntary organization, launched a TB control program on January 1, 1992, for Yelandur taluk, covering a population of 69,484 in 40 villages. A staff consisting of a medical officer, a supervisor, a smear technician, and paramedical workers had undergone training at the National TB Institute in Bangalore. Detection of cases was carried out by house-to-house visits, which could detect about 65\% of cases. It was also found that TB treatment had been started without a sputum examination, sputum-positive cases had been on rifampicin, and data recording was incomplete. Up to October 1994, a total of 231 cases were registered and compliance was ensured by home visits. Private practitioners were carrying out harmful activities by not enforcing full patient compliance and thereby contributing to the increasing number of drug-resistant cases. In contrast, this program had a default of only 19.1\% among sputum-positive cases, but even these can be recovered with an interaction with private practitioners. Treatment failure amounted to 10.1\%, all having been on rifampicin. Retreatment requires more expensive second-line drugs. Drug collection will be decentralized for the convenience of patients; and an adequate supply of drugs was secured. Some suggestions were also made concerning adequate resources, integration of the program, monitoring, and involving nongovernmental organizations in implementation and evaluation.
This article was published in Health Millions
and referenced in Primary Healthcare: Open Access