Several unprecedented features make this new TB program of India virtually a paradigm shift from the past:
1. The core element is supervision. Home address of each patient is carefully recorded and verified on day one. He thus becomes traceable and can’t default and disappear. A close watch is kept over him; he comes to the DOTS center to swallow his doses right in front of a health worker who even goes to his house if he fails to show up.
2. One fundamental change, long overdue, was belatedly ushered in – a generational switch in chemotherapy – from less effective to best medicines that cure the patient speedily, within 6 to 8 months.
3. A separate box for each patient: As soon as a patient is diagnosed, a box containing complete 6-month quota of medicines is earmarked for him; only he – and no one else – will be given strips from that box. So, now treatment never fails due to drug-shortage. It also simplifies drug logistics. Furthermore, all tests and drugs are provided free of cost.
4. Another drastic change is that now patient takes medicines on alternate days – and not daily as always in the past. ‘Thrice-weekly’instead of the traditional, time tested ‘daily regime’ has been introduced. ‘Given just thrice a week, TB medicines are equally effective’ claim several studies.
Massive compliance failure (60%) in the past makes supervision an absolute necessity. And supervision becomes feasible only in a thrice-weekly regime; since patient can practically visit dispensary no more than three times a week. Daily regime is unsuitable since a patient can’t come daily and be supervised while taking his dose.
Besides, there is yet another irresistible feature of thrice-weekly regime – the cost gets reduced to nearly half since, overall, less drugging is involved. In simple terms:
• With the same resources, we could benefit twice as many humans.
• In less than half the estimated cost, we could rid the entire world of TB.
However, even though authenticated by scientific trials, this new thrice weekly (3/7) concept is still in its infancy. Not much time has elapsed since its practice in the field conditions began. It has yet to pass the ultimate test – the test of time.
5. Omission of chest X-ray from the diagnostic algorithm (in case of infectious pulmonary (lung) TB).
6. Absolute reliance on a single test – namely sputum smear microscopy.
7. Exclusion of ‘TB expert.’