A comparison of two methods of undertaking directly observed therapy in a rural Indian setting

SETTING: Jharkband State, rural India. OBJECTIVES: To compare the completion rates of the two tuberculosis control programmes of the Nav Jivan Hospital, Tumbagara, and to show that even in difficult areas, a DOTS programme can be successfully implemented. DESIGN: A retrospective analysis of two DOTS programmes centred on a small rural hospital based on an analysis of case outcome. METHODS: Comparative study between two ways of delivering a DOTS programme. RESULTS: At the end of the treatment period, 359 patients in the hospital unsupervised programme and 158 in the directly observed and hospital checked programme were available for analysis. Completion/cure rates were 64% in the former group and 89.2% in the latter, compared with completion/cure rates of 17% before either programme was adopted. Sputum smear positivity rates were 79.3% and 76.5%, respectively, compared with 6% before the programmes. CONCLUSIONS: A hospital supervised and directly observed treatment (DOT) programme using independent DOT observers can exceed WHO targets for cure/completion rates even in the poorest rural setting.