Decentralization of Treatment Services for Drug Resistant Tuberculosis – A Patient Friendly Strategy from Telangana Region of India
Journal Title: National Journal of Research in Community Medicine - Year 2018, Vol 7, Issue 1
Abstract
Context: Drug Resistant Tuberculosis (DR-TB) is a major public health challenge in India. In 2016, WHO estimates 79,000DR-TB cases among the notified pulmonary TB cases emerging annually in India. Revised National Tuberculosis Control Program had initiated treatment services under Programmatic Management of DR-TB through designated DR-TB Centres for each ~10 million population with 20-30 bedded infection control complaint wards manned by a clinical committee of specialists and trained staff to provide the in-patient care for the initial 2 weeks of treatment. The utilization of services at the DR-TB Centre in Hyderabad, Telangana State serving 10 districts, was observed to be sub-optimal mainly due to long distances to be travelled by the patients. Delay in treatment initiation, loss of wages due to travel and travel cost are major challenges in early initiation of the treatment. Aim: In this report, we present a patient friendly approach initiated in Telangana State to address these gaps. Material and Methods: As a strategic intervention to address these issues, the state TB cell of Telangana developed decentralized district level DR-TB Centres for each ~2 million population with 4-8 bedded ward in each of the 10 districts. These were linked to the DR-TB Centre at Hyderabad that would serve as a nodal-centre for referrals of difficult cases, mentoring and monitoring the quality of the treatment services. Results: The proportion of patients initiated on treatment for DR-TB increased from 69% before decentralization in 2010 (123/178) to 89% (727/817) in 2015 after decentralization (p<0.05). Monitoring of patients who were not initiated on treatment and validation of data at regular intervals was additional yield of the decentralization approach followed in the region. Conclusions: The approach implemented suggest that decentralization of DR-TB treatment services help in early initiation of treatment and also builds confidence in the patients in availing treatment besides supporting the state in preparedness for incremental diagnosis through newer diagnostic tools.
Authors and Affiliations
Chakrapani Chatla, Jyoti Jaju, Shanta Achanta, Suryaprakash Chakramahanty, Prabakaran Jayaraman, Jayakrishna Kurada, Sreenivas Achuthan Nair
Keywords
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- EP ID EP515769
- DOI 10.26727/NJRCM.2018.7.1.11-17
- Views 73
- Downloads 0
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