title: Directly observed treatment short course for tuberculosis. What happens to them in the long term?
abstract: BACKGROUND
  Though Directly Observed Treatment Short course (DOTS) is found effective in many controlled trials, few studies have examined its effectiveness under programmatic conditions. DOTS based Revised National TB Control Programme (RNTCP) was initiated in Ernakulam district of Kerala state in June 2000. It now covers all of India. It now seems appropriate to do an evaluation of RNTCP at field level.
  
  
  OBJECTIVE
  This study aims to document impact of DOTS in providing productive life to tuberculosis patients and measure rate of clinical recurrence under program conditions.
  
  
  METHODS
  Retrospective cohort study using interview with structured, peer reviewed and validated questionnaire among cohort of new smear positive patients registered in RNTCP from January 2002 to December 2003 and declared cured/Treatment completed. We have contacted 1173 patients (62.2% of the cohort) for the study at their homes by devising a strategy to identify and trace patients from address given in TB registers.
  
  
  RESULTS
  Mean age of identified patients is 51.9 years. 82.4% were males. 79% patients report full supervision in the intensive period. After seven years 64.1% are healthy, work and earn; 29.8% report residual respiratory problems; 0.3% of symptomatic patients were diagnosed with smear positive pulmonary tuberculosis. Relapse calculated as worst case scenario for full target population (dead and migrated inclusive) is 9.27%. Age specific mortality is 4-6 times higher than in a comparable general population.
  
  
  CONCLUSIONS
  DOTS treatment under program conditions makes a measurable reduction in tuberculosis morbidity. Though high proportion of patients remains productive after DOTS, a significant proportion complains of residual respiratory symptoms. Age specific mortality of Post tuberculosis patients is high compared to general population. Close follow up irrespective of duration of symptoms may help to determine the causes of high residual morbidity and mortality rates.
authors: Professor of Community Medicine, M.O.SC. Medical College, Kolenchery, India. Electronic address: marina.rajan@gmail.com.
authors: Marina Rajan
authors: MR
authors: Joseph
authors: Senior Lecturer Community Medicine, M.O.SC. Medical College, Kolenchery, India.
authors: Roshan Anna
authors: RA
authors: Thomas
authors: Assistant Professor, Department of Pulmonary Medicine, Govt. Medical College, Trivandrum, India.
authors: Sanjeev
authors: S
authors: Nair
authors: Medical Consultant RNTCP, Office of The WHO Representative for India, India.
authors: Shibu
authors: S
authors: Balakrishnan
authors: State TB Officer, Chest Physician, Directorate of Health Services, Kerala, India.
authors: S
authors: S
authors: Jayasankar
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D023801:Directly Observed Therapy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents
keywords: DOTS outcome; Quality of RNTCP; Relapse after DOTS; Residual respiratory problem; Tuberculosis treatment