FrontLines: Directly Observed TB Treatment Saves Nearly 300,000 in India

March 2004

NEW DELHI—Since 1997, India’s healthcare system has used directly observed treatment to diagnose and treat record numbers of TB patients, saving more than 290,000 lives. The World Health Organization (WHO) chose India as the site of its worldwide TB conference in March 2004 to showcase its successful adoption of DOTS, or directly observed treatment, short-course.

Today, the treatment reaches 80 percent of India’s more than 1 billion people. This is “a brilliant piece of public health,” said Christopher Barrett, USAID/India’s point person for TB.

Though the rapid expansion of DOTS and improved detection increased the work load dramatically, the treatment enables about 84 percent of diagnosed TB cases to be cured.

Maintaining quality care is the biggest challenge, according to Barratt. He said 100 WHO consultants “travel constantly” to make sure their assigned districts have an uninterrupted supply of TB drugs and implement DOTS correctly. The consultants are highly skilled Indian medical professionals who report to the health ministry in New Delhi and WHO in Geneva. They provide one of several quality-control mechanisms, Barratt said.

Annually, India accounts for almost one-third of the world’s new TB cases; 168 people per 100,000 have TB, and about 370,000 Indians die from the disease annually.

Since the 1990s, the Indian government, medical schools, the private sector, and several international donors have equipped laboratories and trained technicians and medical practitioners to diagnose and treat TB.

Between 1998 and 2003, USAID provided $13.2 million for equipment, training, and policy assistance. The mission focused on four states—Haryana, Maharashtra, Tamil Nadu, and Uttar Pradesh.

In Haryana, USAID helped equip and establish 135 centers with microscopes, lab tables, and supplies for collecting and testing sputum samples. USAID also worked with private medical associations and seven medical school faculties to build DOTS into curricula. In turn, the seven colleges are working with 173 other medical schools in India to teach DOTS to young doctors.

One of the Agency’s first investments in the 1990s DOTS program was support for the Tuberculosis Research Center at Chennai (formerly called Madras), which introduced DOTS in the southern state of Tamil Nadu in 1993. The center carefully documented the effectiveness of DOTS and helped convince the Indian government to go nationwide with the program.

The center, which USAID still supports, contributes regularly to domestic and foreign medical journals on its work, including its contributions to preventing TB infection among the HIV-positive and monitoring and treating multiple-drug resistant TB.

Access the March 2004 edition of FrontLines [PDF, 2MB].