Directly observed intermittent short-course chemotherapy in the Kathmandu valley

Abstract

Setting: Within the national tuberculosis control programme in Nepal, cure rates of only 30%-40% were achieved using standard chemotherapy. High cure rates are particularly difficult to achieve in the Kathmandu valley, because of the mobility of the population and the large numbers of private practitioners. Short-course chemotherapy (SCC) was not used in tuberculosis (TB) control programmes in Nepal before 1991. Therefore we started our pilot programme with a fully supervised, intermittent SCC regimen. In addition we established a mycobacteriological laboratory for routine culture and susceptibility tests.

Objective: The main objective was to demonstrate the high effectiveness of a three-times weekly SCC regimen and the feasibility of directly observed treatment (DOT).

Design: In our new out-patient department we put all active TB patients under SCC. The duration of therapy was 9 months or longer, depending upon bacteriological and radiological needs. The results were well recorded and evaluated by central supervision. Outcome of treatment was recorded at 24-48 months.

Results: From January 1990 to December 1993, 771 pulmonary TB patients (618 new cases and 153 old cases) commenced treatment. Of these, 645 (84%) were cured or completed treatment, 84 (11%) defaulted, 15 (2%) died, 15 (2%) were treatment failures and 12 (3.0%) relapsed.

Conclusion: Directly observed intermittent SCC is highly cost-effective. The results of our service programme showed that it is possible to introduce such a regimen in an urban area of Nepal.