c s j c
DESCRIPTION
This was the presentation presented at the first meeting of the Cochrane Student Journal Club on 24th March 2010 about the effectiveness of DOTSTRANSCRIPT
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Case
A 45 year old man presents with persistent cough for the past 3 months, low grade fever, and abdominal pain.
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Provisional Diagnosis
1. TB
2. TB
3. TB
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• India has one of the highest cases reported of TB in the world
• TB is controlled in India by the DOTS(Direct Observation Therapy, Short course) programme as recommended by the WHO
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What is DOTS?
• Directly observed treatment (DOT) or directly observed therapy is watching the patient take his/her medication to ensure medications are taken in the right combination and for the correct duration
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Five components of DOTS
• Government commitment • Case detection by sputum smear microscopy • Standardized treatment regimen with directly
observed treatment for at least the first two months
• A regular drug supply • A standardized recording and reporting system
that allows assessment of treatment results
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Facts
• The Indian Government has spent over $200 million on setting up the DOTS programme 1
• “DOTS lost track of more than 35,000 patients last year” The Telegraph
• “Nearly 70,000 people suffering from multi-drug resistant tuberculosis (MDR-TB) in India require quality second-line treatment, experts at the World Health Organization say. India needs quality second-line drugs to treat these patients ..." - The Hindu
1 www.indiatogether.com
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How effective is DOTS?
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[Intervention Review]
Directly observed therapy for treating tuberculosis
Jimmy Volmink1, Paul Garner2
1Faculty of Health Sciences, University of Stellenbosch, Tygerberg, South Africa
2International Health Group, Liverpool School of Tropical Medicine, Liverpool, UK
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Objective
To compare DOT with self administration of treatment or different DOT options for people requiring treatment for clinically active tuberculosis or prevention of active disease.
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Study Methods
• This systematic review evaluated 11 Randomized Control Trial (RCT’s) with 5906 participants from all economic strata’s of society.
• Trials of drug users were analysed separately• Data were analysed using relative risks (RR) with
95% confidence intervals (CI) and the fixed-effect model when there was no statistically significant heterogeneity (chi square P > 0.1).
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Study Methods
• The control was routine self administration of treatment at home, with intermittent clinic visits for drugs with or without treatment adherence checks.
• All studies on the topic, irrespective of language of publication and origin were looked into.
• For papers that had not been published the authors were contacted to verify the validity and level of bias in the study
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Result
The results of randomized controlled trials conducted in low-, middle-, and high-income countries provide NO assurance that DOT compared with self administration of treatment has any quantitatively important effect on cure or treatment completion in people receiving treatment for tuberculosis
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Food for Thought
In a country like India were 900 million people survive on Rs. 80 per day, how much difference would it make to their lives if $200 million were spent on there up liftment instead of wasting it on setting up a system that is not effective.
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Thank You
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Thank You