Dr. Archie Cochrane
<ul><li>Case </li></ul><ul><li>A  45 year old man presents with persistent cough for the past 3 months, low grade fever, a...
Provisional Diagnosis <ul><li>TB </li></ul><ul><li>TB </li></ul><ul><li>TB </li></ul>
<ul><li>India has one of the highest cases reported of TB in the world </li></ul><ul><li>TB is controlled in India by the ...
What is DOTS?  <ul><li>Directly observed treatment  (DOT) or  directly observed therapy  is watching the patient take his/...
 
Five components of DOTS <ul><li>Government commitment  </li></ul><ul><li>Case detection by sputum smear microscopy  </li><...
 
Facts <ul><li>The Indian Government has spent over $200 million on setting up the DOTS programme  1 </li></ul><ul><li>“ DO...
How effective is DOTS?
<ul><li>[Intervention Review] </li></ul><ul><li>Directly observed therapy for  treating tuberculosis </li></ul><ul><li>Jim...
Objective <ul><li>To compare DOT with self administration of treatment or different DOT options for people requiring treat...
Study Methods <ul><li>This systematic review evaluated 11 Randomized Control Trial (RCT’s) with 5906 participants from all...
Study Methods  <ul><li>The control was routine self administration of treatment at home, with intermittent clinic visits f...
Result <ul><li>The results of randomized controlled trials conducted in low-, middle-, and high-income countries provide  ...
 
Food for Thought <ul><li>In a country like India were 900 million people survive on Rs. 80 per day, how much difference wo...
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C S J C

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This was the presentation presented at the first meeting of the Cochrane Student Journal Club on 24th March 2010 about the effectiveness of DOTS

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  • Show of hands
  • C S J C

    1. 2. Dr. Archie Cochrane
    2. 3. <ul><li>Case </li></ul><ul><li>A 45 year old man presents with persistent cough for the past 3 months, low grade fever, and abdominal pain. </li></ul>
    3. 4. Provisional Diagnosis <ul><li>TB </li></ul><ul><li>TB </li></ul><ul><li>TB </li></ul>
    4. 5. <ul><li>India has one of the highest cases reported of TB in the world </li></ul><ul><li>TB is controlled in India by the DOTS ( D irect O bservation T herapy, S hort course) programme as recommended by the WHO </li></ul>
    5. 6. What is DOTS? <ul><li>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 </li></ul>
    6. 8. Five components of DOTS <ul><li>Government commitment </li></ul><ul><li>Case detection by sputum smear microscopy </li></ul><ul><li>Standardized treatment regimen with directly observed treatment for at least the first two months </li></ul><ul><li>A regular drug supply </li></ul><ul><li>A standardized recording and reporting system that allows assessment of treatment results </li></ul>
    7. 10. Facts <ul><li>The Indian Government has spent over $200 million on setting up the DOTS programme 1 </li></ul><ul><li>“ DOTS lost track of more than 35,000 patients last year” The Telegraph </li></ul><ul><li>“ 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 ...&quot; - The Hindu </li></ul><ul><li>1 www.indiatogether.com </li></ul>
    8. 11. How effective is DOTS?
    9. 12. <ul><li>[Intervention Review] </li></ul><ul><li>Directly observed therapy for treating tuberculosis </li></ul><ul><li>Jimmy Volmink 1 , Paul Garner 2 </li></ul><ul><li>1 Faculty of Health Sciences, University of Stellenbosch, Tygerberg, South Africa </li></ul><ul><li>2 International Health Group, Liverpool School of Tropical Medicine, Liverpool, UK </li></ul>
    10. 13. Objective <ul><li>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. </li></ul>
    11. 14. Study Methods <ul><li>This systematic review evaluated 11 Randomized Control Trial (RCT’s) with 5906 participants from all economic strata’s of society. </li></ul><ul><li>Trials of drug users were analysed separately </li></ul><ul><li>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). </li></ul>
    12. 15. Study Methods <ul><li>The control was routine self administration of treatment at home, with intermittent clinic visits for drugs with or without treatment adherence checks. </li></ul><ul><li>All studies on the topic, irrespective of language of publication and origin were looked into. </li></ul><ul><li>For papers that had not been published the authors were contacted to verify the validity and level of bias in the study </li></ul>
    13. 16. Result <ul><li>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 </li></ul>
    14. 18. Food for Thought <ul><li>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. </li></ul>
    15. 19. Thank You
    16. 20. Thank You

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