DOTS for TB relapse in India: A systematic review

Abstract

In India, under the Revised National Tuberculosis Control Program (RNTCP), the percentage of smear-positive re-treatment cases is high. The causes of re-treatment include relapse of the disease after successful completion of treatment, treatment failure, and default in treatment. RNTCP does not follow up the patients for any period of time after successful completion of treatment to determine whether they relapse. Given the high cost of treatment for each patient under RNTCP and the potential for spread of disease from these patients, it is crucial for the success of the program and control of the disease in the country to find out more about the reasons behind this. T0 o conduct a systematic review of literature and determine evidence regarding recurrence of TB after its successful treatment with standard short course chemotherapy under DOTS guidelines. T0 en databases were searched including Medline, Cochrane database, Embase and others and reference lists of articles. 255 papers resulted from these searches. Seven studies were finally included in the review after applying the inclusion, exclusion and quality assessment criteria. R0 elapse rate is high (almost 10%) in India which is higher than international studies. Majority of relapse cases present soon after completion of treatment (first six months). Risk factors for relapse included drug irregularity, initial drug resistance, smoking and alcoholism Sex and weight were not risk factors in India. The outcome of relapse cases put on treatment is positive but less effective than new cases. There are sound arguments and sketchy evidence that DOTS Category 2 treatment may not be adequate for retreatment patients.

Is the directly observed therapy short course (DOTS) an effective strategy for tuberculosis control in a developing country?

“…PubMed provided 22 articles while Popline, Global Health and Web of Science provided 6,10 and 6 articles respectively. The organizational website and search engines collectively provided 6 articles.…”

“…A systematic review in 2012 by Azhar studied recurrence of TB after its successful treatment with standard short course chemotherapy under DOTS guidelines in India [22] . Seven studies were included in this review after applying the inclusion, exclusion and quality assessment criteria.…”

Public private mix in tuberculosis control: is it really working in India?

“…This apprehension among the PPs about the intermittent therapy was however not baseless, as a systematic review in India had reported high relapse rate (10%) among new TB patients treated with RNTCP treatment regimen. 22 However, the recent shift of the RNTCP from intermittent to daily regimen seems to be a step forward in right direction to minimize this gap between PPs and RNTCP. We found that about 29.6% PPs felt ignored by RNTCP.…”

Rapid assessment of facilitators and barriers related to the acceptance, challenges and community perception of daily regimen for treating tuberculosis in India

“…Studies done in several parts of the country show that relapses are closer to 10% or more in patients who received intermittent treatment compared with 5% among patients who received drugs daily [11]. Therefore the decision to continue with an intermittent therapy for TB control was considered inadequate to address the complex challenges posed by the disease.…”