Perception of DOTS providers on changes in tuberculosis case management: Comparison of alternate day and daily treatment regimens using mixed method design in Mandya district.

ABSTRACT

BACKGROUND: Tuberculosis case management has undergone various changes in recent years. Most of the decisions have been taken based on provider intelligence or perspective. It is essential to know the beneficiary perspective about the changes in RNTCP. DOTS providers are active witnesses for the series of changes and they have first hand experience of effect of these changes on TB patients. Thus it is ideal to learn from DOTS providers, about comparative strengths and limitations of the new strategy and effects of the changes. METHODS: Study design Mixed method using survey and matrix ranking method. STUDY POPULATION DOTS providers who have supervised at least one patient before the daily regimen and completed at-least intensive phase of one patient in daily regimen. Study was conducted in Mandya district between May-June 2019 involving 25 DOTS providers selected through snowball sampling technique. Data collection was done using proforma and Matrix ranking technique using 10 stones. Thematic analysis, wilcoxon sign rank test were used for analysis. RESULTS: Significant improvement was reported by DOTS providers in new regimen with respect to compliance, treatment response, ease of supervision and patient attitude towards outcome. Related to drug supply system, there was no significant difference. CONCLUSIONS: There was significant improvement in compliance, response, ease of supervision and patient attitude. Significant reduction in side effects in daily regimen compared to alternate day regimen. NPY is helping poor and elderly patients but irregular payment is an issue. Remuneration of DOTS providers was not consistent.