DOTS PLUS OF MDR TUBERCULOSIS
The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly multidrug-resistant TB (MDR-TB), has become a significant public health problem in a number of countries and an obstacle to effective TB control. In India, the available information from the several drug resistance surveillance studies conducted in the past suggest that the rate of MDR-TB is relatively low in India, this translates into a large absolute number of cases and as yet the management of patients with MDR-TB is inadequate. Specific measures are being taken within the Revised National Tuberculosis Control Programme (RNTCP) to address the MDR-TB problem through appropriate management of patients and strategies to prevent the propagation and dissemination of MDR-TB.
Traditionally, DOTS-Plus refers to DOTS programmes that add components for MDR-TB diagnosis, management and treatment. These guidelines promote full integration of DOTS and DOTS-Plus activities under the RNTCP, so that patients with MDR-TB are both correctly identified and properly managed under the recommendations set out in this document.
Special considerations for DOTS-Plus
DOTS-Plus is more complex than the basic DOTS strategy. For DOTS-Plus to be successful, special attention is needed for the following:
• Quality-assured laboratory capacity (smear, culture and DST);
• Treatment design;
• Adherence to difficult-to-take regimens for long periods;
• Side-effect management;
• Drug procurement;
• Recording and reporting; and
• Human and financial resource constraints.
The method of case finding is designed taking into consideration the resources and technical capacity available to the RNTCP at this time. Also the DOTS-Plus treatment regimen for MDR-TB has been tailored to the Indian setting. Many health care providers have little or no experience with second-line drugs and their side effects, especially in combinations of 4 to 6 at a time. The framework...