India should introduce daily drug treatment for tuberculosisBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6769 (Published 11 November 2013) Cite this as: BMJ 2013;347:f6769
- Yogesh Jain, public health physician and paediatrician, Jan Swasthya Sahyog (People’s Health Support Group), Village and Post Office Ganiyari, Bilaspur 495112, India
The revised national tuberculosis control programme (RNTCP) was launched in India in 1997 based on World Health Organization advised directly observed treatment strategy (DOTS), with treatment given three times a week. The lower cost of drugs and feasibility of supervised dosing were factors thought to favour intermittent treatment. Although intermittent therapy in tuberculosis is pharmacologically acceptable, there was little hard evidence to support this regimen. India was among 132 countries that adopted this WHO strategy. Although not explicitly stated, the programme assumed that new patients with tuberculosis were likely to have disease that would respond to drugs, and those receiving retreatment were unlikely to have multidrug resistant (MDR) disease.
The revised programme has done well compared with the previous national programme thanks to improved funding, the rifampicin based regimen, and direct observation. The programme’s success was defined as a case detection rate of 70% and treatment completion and sputum conversion rates of 85%, and these were largely achieved. However, the programme did not collect data about relapses and the emergence of drug resistance.
Studies done in several parts of …