title: Directly-observed and self-administered tuberculosis treatment in a chronic, low-intensity conflict setting in India.
abstract: BACKGROUND
  Limited data are available about tuberculosis treatment models of care for internally displaced populations in chronic, low-intensity conflict zones. This study aimed to detail experiences of a Médecins Sans Frontières tuberculosis programme in Andhra Pradesh-Chhattisgarh border area, India, from January to December 2012.
  
  
  METHODS
  The study was a description of two retrospective, observational cohorts receiving category I tuberculosis treatment, either intermittent directly observed treatment (DOT) or daily self-administered therapy (SAT) depending on the security of the area and access to health care services.
  
  
  RESULTS
  A total of 55 and 17 new tuberculosis patients under DOT and SAT respectively, with complete outcomes were included in the study. Most patients registered were new cases suffering from pulmonary, smear-positive tuberculosis. More than half of the patients in both cohorts were cured or completed treatment: 38/55 (69%) patients were successfully treated under DOT compared to 9/17 (53%) under SAT. Of the patients with adverse outcomes, the ratios of loss to follow up: failure: died were 10:4:3 under DOT and 7:0:1 under SAT. A much smaller proportion of patients under DOT (18%) were lost to follow up than under SAT (41%).
  
  
  CONCLUSIONS
  Maximum efforts are required to implement successful tuberculosis control programmes for internally displaced populations in conflict zones. Our study suggests that complete tuberculosis treatment can be given to patients using either intermittent DOT or daily SAT, depending on security and access to health services. National TB programmes should include SAT strategies for tuberculosis treatment as these may be an alternative feasible option in conflict settings.
authors.affiliation: Operational Research, Médecins Sans Frontières, New Delhi, Delhi, India.
authors.forename: Mrinalini
authors.initials: M
authors.lastname: Das
authors.affiliation: Operational Research, Médecins Sans Frontières, New Delhi, Delhi, India.
authors.forename: Petros
authors.initials: P
authors.lastname: Isaakidis
authors.affiliation: Operational Research, Médecins Sans Frontières, New Delhi, Delhi, India.
authors.forename: Edward
authors.initials: E
authors.lastname: Armstrong
authors.affiliation: Operational Research, Médecins Sans Frontières, New Delhi, Delhi, India.
authors.forename: Nirmala Rani
authors.initials: NR
authors.lastname: Gundipudi
authors.affiliation: District TB Control Office, RNTCP, Khammam district, Andhra Pradesh, India.
authors.forename: Ramesh B
authors.initials: RB
authors.lastname: Babu
authors.affiliation: Operational Research, Médecins Sans Frontières, New Delhi, Delhi, India.
authors.forename: Ihtesham A
authors.initials: IA
authors.lastname: Qureshi
authors.affiliation: Operational Research, Médecins Sans Frontières, New Delhi, Delhi, India.
authors.forename: Andrea
authors.initials: A
authors.lastname: Claes
authors.affiliation: Operational Research, Médecins Sans Frontières, New Delhi, Delhi, India.
authors.forename: Anil Kumar
authors.initials: AK
authors.lastname: Mudimanchi
authors.affiliation: Operational Research, Médecins Sans Frontières, New Delhi, Delhi, India.
authors.forename: Nagendra
authors.initials: N
authors.lastname: Prasad
authors.affiliation: Operational Research, Médecins Sans Frontières, New Delhi, Delhi, India.
authors.forename: Homa
authors.initials: H
authors.lastname: Mansoor
authors.affiliation: Operational Research, Médecins Sans Frontières, New Delhi, Delhi, India.
authors.forename: Sunita
authors.initials: S
authors.lastname: Abraham
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003710:Demography; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D012646:Self Administration; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*