Effective participation of TB sanatoria in Revised National TB Control Programme (DOTS) in a metropolitan city.

BACKGROUND: Revised National TB Control Programme has been implemented since 1998 in Bangalore metropolitan city which has several big general hospitals, including two TB sanatoria which attract a large number of respiratory symptomatic and TB patients. Till recently there was significant loss of patients for follow up because of lack of mechanism to reach the patients, good recording practices and linkage with district TB control office. OBJECTIVE: To establish an effective referral mechanism between TB sanatoria and peripheral health institutions of the government for providing un-interrupted supervised treatment (DOT) to all newly detected TB patients. METHOD: TB sanatoria remain as "islands" when Reyised National TB Control Programme (RNTCP) with DOTS strategy is implemented. Damien Foundation India Trust (DFIT) provided a Technical Support Team (one medical consultant and three supervisors) to assist in implementation of RNTCP in the district. DFIT liaised with both partners and established procedures for recording correct address, informing health institutions and Senior TB Supervisors (STS) and monitoring referrals. Referral slip and a copy of treatment card were given to patients. One copy of treatment card was sent to respective health facility. Initially the number of STS was not adequate to follow up the patients. The supervisors of Technical Support Team ensured that they were treated in peripheral health institutions or near patients' residence. All STS were in position one year after initiation of this effort. RESULTS: The referral system is functional. Case holding improved from about 50% to 85% during 2002-2005 by effective transfer through referrals. CONCLUSION: Interfacing of NGO between district TB control office and TB sanatoria enabled the establishment of effective collaboration. Initial reluctance was replaced by complete participation in the TB control programme.