Thakkar Dharitri, Piparva Kiran G, Lakkad Suresh G
Department of TB and Chest, P.D.U. Government Medical College, Rajkot, Gujarat, India.
Department of Pharmacology, P.D.U. Government Medical College, Rajkot, Gujarat, India.
Lung India. 2019 Mar-Apr;36(2):108-111. doi: 10.4103/lungindia.lungindia_86_18.
99DOTS (Directly Observed Treatment, Short course) is a low-cost, mobile phone-based technology that enables real-time remote monitoring of daily intake of treatment, first introduced by the Revised National Tuberculosis Programme under the national programme in 2015 in high-burden antiretroviral therapy (ART) centers. This project was launched for the first time in 2016 in Rajkot district, Gujarat, India, and hence this was an effort to evaluate 99DOTS.
The objective of this study was to evaluate treatment adherence rate and treatment outcome of 99DOTS-information communication technology (ICT)-based approach for tuberculosis (TB) management.
Data from 99DOTS were obtained from February 2016 to September 2017 after obtaining approval from the Institutional Ethical Committee and permission from the head of the department of district TB center (DTC), Rajkot. Data were evaluated for sociodemographic pattern, adherence rate, and treatment outcome.
A total of total 347 registered patients, 197 (56.77%) patients diagnosed by private practitioners and 150 (43.22%) patients having HIV-TB from ART center were initiated TB treatment under 99DOTS project from nine different talukas of Rajkot district. Mean age of the registered TB patients was 36 ± 13.55 years with predominance of "new cases" (n = 275, 79.25%) and "male" gender (n = 257, 74.06%). The overall treatment adherence rate of 99DOTS was 96.03%, while adherence by "call" was 92.25% and adherence by "manual" was 32.12%. Cure rate was higher in patients with TB only (n = 113, 78.47%) as compared to patients with HIV-TB co-infection (n = 46, 67.64%). Defaulter rate (n = 19, 13.19%) was also higher in patients with TB only, while death rate (n = 14, 20.58%) was higher in patients of TB with HIV co-infection.
99DOTS is an effective approach for improving TB medication adherence, thereby increasing the compliance to TB treatment. It will be helpful for easy access of treatment to patients from remote areas, improve notification of patients from private practitioners, and enable differentiated care.
99DOTS（直接观察短程治疗）是一种低成本的、基于手机的技术，可实现对治疗每日摄入量的实时远程监测，于2015年由国家修订后的结核病规划在高负担抗逆转录病毒治疗（ART）中心首次引入。该项目于2016年在印度古吉拉特邦拉杰果德县首次启动，因此这是一项对99DOTS进行评估的工作。
本研究的目的是评估基于99DOTS信息通信技术（ICT）的结核病管理方法的治疗依从率和治疗结果。
在获得机构伦理委员会批准和拉杰果德县结核病中心（DTC）部门负责人许可后，获取了2016年2月至2017年9月期间来自99DOTS的数据。对数据进行社会人口统计学模式、依从率和治疗结果评估。
共有347名登记患者，其中197名（56.77%）由私人执业医生诊断，150名（43.22%）来自ART中心的HIV-TB患者在拉杰果德县9个不同的塔卢卡地区的99DOTS项目下开始接受结核病治疗。登记的结核病患者平均年龄为36±13.55岁，以“新病例”（n = 275，79.25%）和“男性”（n = 257，74.06%）为主。99DOTS的总体治疗依从率为96.03%，通过“呼叫”的依从率为92.25%，通过“手动”的依从率为32.12%。仅患结核病的患者（n = 113，78.47%）的治愈率高于合并HIV-TB感染的患者（n = 46，67.64%）。仅患结核病的患者的违约率（n = 19，13.19%）也较高，而合并HIV感染的结核病患者的死亡率（n = 14，20.58%）较高。
99DOTS是提高结核病药物依从性的有效方法，从而提高对结核病治疗的依从性。它将有助于偏远地区的患者方便地获得治疗，改善私人执业医生对患者的报告，并实现差异化护理。
