10.6 DOT providers

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To ensure adherence to treatment, DOTS should be provided with the objective of maximising the patient’s convenience. This often means making necessary arrangement for DOTS as close to the patient's home or workplace as possible. If the patient wishes to attend any of the NTP recognized DOTS centres to take their medication, then this should be arranged in consultation with the patient.

The DOTS provider may be a facility or community-based health worker or a trained community member. These DOTS providers include TB & Leprosy Control Assistant (TLCA), assistant health inspectors (AHIs), health assistants (HAs), community health care providers (CHCP), community health workers (CHWs), Shasthya shebikas, village doctors, community leaders, cured patients, etc. All non-medical DOTS providers should be supervised at least once a month.

Medical officers and paramedics in consultation with patients, should identify the DOTS provider, the name and address of whom should be recorded on the patient's treatment card. The medical officer or paramedic has to ensure that the DOTS provider receives the filled-up copy of Treatment Card (TB 01), Identity Card (TB 02) and drugs at the specified intervals.

10.6.1 Drug supplies to DOT providers

If DOT is provided at the centre where the patient is registered, the drugs for that patient for the whole course of the treatment should be arranged and kept at a secured and suitable place in that centre. The paramedic responsible for DOT should be given the drugs for two weeks at a time.

If DOT is provided from a sub-centre, where the patient is not registered for the treatment or at community level by a health worker/village doctor/shasthya shebika drugs needed for two to four weeks should be given at a time to the DOT provider until the end of the treatment.

10.6.2 Regularity of treatment

DOTS providers should ensure that the patients swallow the drugs according to prescription. They should take up prompt action for tracing and retrieval of patients who miss their doses and prevent patients from becoming lost to follow up. Priority must be given to smear-positive pulmonary TB patients. If a patient misses three consecutive doses of the treatment, he/she must be traced immediately to resume DOTS without delay.

To ensure easy tracing of patients the detailed address should be filled up on the Tuberculosis Treatment Card and TB Register (valid Mobile number should be included if available with the patient). The patients should be encouraged by the DOTS providers to visit the treatment initiation centre fortnightly during the intensive phase so that the patient can be evaluated for any adverse events as well as to assess prognosis by evaluating the remission of symptoms, weight gain etc.

10.6.3 Methods of DOT