Dataset Information

Private patient perceptions about a public programme; what do private Indian tuberculosis patients really feel about directly observed treatment?

ABSTRACT: BACKGROUND: India accounts for one-fifth of the global incident cases of tuberculosis(TB). The country presently has the world's largest directly observed treatment, short course (DOTS) programme, that has shown impressive results and covers almost 100% of the billion-plus Indian population. Despite such a successful programme, the majority of Indian patients with tuberculosis prefer private healthcare, although repeated audits of this sector have shown the quality to be poor. We aimed to ascertain the level of awareness and knowledge of private patients with tuberculosis attending our clinic at a tertiary private healthcare institute with regards to the DOTS programme, understanding the reasons behind their preference for private healthcare, and evaluating their perceptions and reasons for accepting or failing to accept directly observed therapy as a treatment option. METHODS: A structured interview schedule was administered to private patients with tuberculosis at the P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India between January 2006 to November 2007. RESULTS: Only 30 of 200 patients (15%) were aware of the DOTS programme. After being explained what directly observed therapy was, 136 patients (68%) found this form of treatment unacceptable.183 patients (91.5%) preferred buying the drugs themselves to visiting a DOTS centre. 90 patients (45%) were not prepared to be observed while swallowing their TB drugs, finding it an intrusion of privacy. CONCLUSIONS: Our study reveals a poor knowledge and awareness of the DOTS programme among the cohort of TB patients that we interviewed. The control of TB in India will undoubtedly benefit from more patients being attracted to and treated by the existing DOTS programmes. However, directly observed treatment, in its present form, is considered too rigid and intrusive and is unlikely to be accepted by a majority of patients seeking private healthcare. Novel strategies and more flexible options will have to be devised to ensure higher cure rates without compromising patient choice.

SUBMITTER: Pinto LM

PROVIDER: S-EPMC2903519 | biostudies-other | 2010

REPOSITORIES: biostudies-other

ACCESS DATA

Publications

Private patient perceptions about a public programme; what do private Indian tuberculosis patients really feel about directly observed treatment?

Pinto Lancelot M LM Udwadia Zarir F ZF

BMC public health 20100622

<h4>Background</h4>India accounts for one-fifth of the global incident cases of tuberculosis(TB). The country presently has the world's largest directly observed treatment, short course (DOTS) programme, that has shown impressive results and covers almost 100% of the billion-plus Indian population. Despite such a successful programme, the majority of Indian patients with tuberculosis prefer private healthcare, although repeated audits of this sector have shown the quality to be poor. We aimed to ...[more]

PMID: 20569448

Similar Datasets

Project description:ImportanceDespite broad public support for gun safety policies, minimal policy implementation has occurred.ObjectiveTo investigate factors that encourage greater private support for and public action on gun safety policy.Design, setting, and participantsThree studies were conducted: a public opinion survey (Study 1) was conducted from January 8 to 22, 2019, and 2 experiments (Studies 2 and 3) were conducted from August 27 to October 17, 2019, and April 15 to 21, 2020, respectively. Adults living in the US were eligible to participate in Studies 1 and 3. Students 18 years and older participating in a research experience program were eligible to participate in Study 2. Study 1 was administered online by Ipsos, a market research company. A nationally representative sample of 1000 US adults was obtained from Ipsos' online KnowledgePanel, of whom 508 completed the public opinion survey. For Study 2, which was conducted in a university laboratory, 354 participants were recruited from a university research pool, all of whom completed the study. Study 3 was administered online by the market research company YouGov, which identified 727 US gun owners from its opt-in panel, from which it constructed a census-matched sample of 400 participants.ExposuresParticipants read a statement about the 2018 Marjory Stoneman Douglas High School shooting. Content was manipulated as a 2 (corrective information vs no corrective information) × 2 (system changeable vs system not changeable) between-subjects factorial design with random assignment. The corrective information included polling data highlighting widespread support among gun owners for several gun safety policies. System changeable described gun safety policies passed by Florida's legislature.Main outcomes and measuresMain outcomes were support for gun safety policies and public disclosure of support.ResultsThe 3 studies included a total of 1262 participants (Study 1: 508 participants; weighted mean [SD] age, 47.7 [17.5] years; 261.9 women [51.6%]; 82.5 Hispanic [16.2%] and 60.3 Black [11.9%]; Study 2: 354 participants; mean [SD] age, 20.0 [2.3] years; 232 women [65.9%]; 100 Asian [28.3%] and 37 Black [10.5%]; Study 3: 400 participants; weighted mean [SD] age, 52.1 [16.4] years; 187.3 women [46.8%]; 295.5 White [73.9%], 44.5 Hispanic [11.1%], and 32.4 Black [8.1%]). Study 1 found that 63% to 91% of gun owners and 83% to 93% of non-gun owners supported key gun safety policies, yet both groups significantly underestimated gun owners' support for these policies by between 12% and 31%. Studies 2 and 3 found that exposure to corrective information was associated with a small increase in support for 2 gun safety policies of between 4% and 15%, both in terms of participants' privately held beliefs and the beliefs they would be willing to share publicly.Conclusions and relevanceThis survey study found that many US adults failed to recognize that most gun owners support key gun safety policies. Correcting this misperception was associated with greater private and public support for gun safety policy.

Project description:BackgroundDirectly observed treatment (DOT) has been the standard of care for tuberculosis since the early 1990s, but it is inconvenient for patients and service providers. Video-observed therapy (VOT) has been conditionally recommended by WHO as an alternative to DOT. We tested whether levels of treatment observation were improved with VOT.MethodsWe did a multicentre, analyst-blinded, randomised controlled superiority trial in 22 clinics in England (UK). Eligible participants were patients aged at least 16 years with active pulmonary or non-pulmonary tuberculosis who were eligible for DOT according to local guidance. Exclusion criteria included patients who did not have access to charging a smartphone. We randomly assigned participants to either VOT (daily remote observation using a smartphone app) or DOT (observations done three to five times per week in the home, community, or clinic settings). Randomisation was done by the SealedEnvelope service using minimisation. DOT involved treatment observation by a health-care or lay worker, with any remaining daily doses self-administered. VOT was provided by a centralised service in London. Patients were trained to record and send videos of every dose ingested 7 days per week using a smartphone app. Trained treatment observers viewed these videos through a password-protected website. Patients were also encouraged to report adverse drug events on the videos. Smartphones and data plans were provided free of charge by study investigators. DOT or VOT observation records were completed by observers until treatment or study end. The primary outcome was completion of 80% or more scheduled treatment observations over the first 2 months following enrolment. Intention-to-treat (ITT) and restricted (including only patients completing at least 1 week of observation on allocated arm) analyses were done. Superiority was determined by a 15% difference in the proportion of patients with the primary outcome (60% vs 75%). This trial is registered with the International Standard Randomised Controlled Trials Number registry, number ISRCTN26184967.FindingsBetween Sept 1, 2014, and Oct 1, 2016, we randomly assigned 226 patients; 112 to VOT and 114 to DOT. Overall, 131 (58%) patients had a history of homelessness, imprisonment, drug use, alcohol problems or mental health problems. In the ITT analysis, 78 (70%) of 112 patients on VOT achieved ≥80% scheduled observations successfully completed during the first 2 months compared with 35 (31%) of 114 on DOT (adjusted odds ratio [OR] 5·48, 95% CI 3·10-9·68; p<0·0001). In the restricted analysis, 78 (77%) of 101 patients on VOT achieved the primary outcome compared with 35 (63%) of 56 on DOT (adjusted OR 2·52; 95% CI 1·17-5·54; p=0·017). Stomach pain, nausea, and vomiting were the most common adverse events reported (in 16 [14%] of 112 on VOT and nine [8%] of 114 on DOT).InterpretationVOT was a more effective approach to observation of tuberculosis treatment than DOT. VOT is likely to be preferable to DOT for many patients across a broad range of settings, providing a more acceptable, effective, and cheaper option for supervision of daily and multiple daily doses than DOT.FundingNational Institute for Health Research.

Project description:Background: Excellent adherence to tuberculosis (TB) treatment is critical to cure TB and avoid the emergence of resistance. Wirelessly observed therapy (WOT) is a novel patient self-management system consisting of an edible ingestion sensor (IS), external wearable patch, and paired mobile device that can detect and digitally record medication ingestions. Our study determined the accuracy of ingestion detection in clinical and home settings using WOT and subsequently compared, in a randomized control trial (RCT), confirmed daily adherence to medication in persons using WOT or directly observed therapy (DOT) during TB treatment.Methods and findings: We evaluated WOT in persons with active Mycobacterium tuberculosis complex disease using IS-enabled combination isoniazid 150 mg/rifampin 300 mg (IS-Rifamate). Seventy-seven participants with drug-susceptible TB in the continuation phase of treatment, prescribed daily isoniazid 300 mg and rifampin 600 mg, used IS-Rifamate. The primary endpoints of the trial were determination of the positive detection accuracy (PDA) of WOT, defined as the percentage of ingestions detected by WOT administered under direct observation, and subsequently the proportion of prescribed doses confirmed by WOT compared to DOT. Initially participants received DOT and WOT simultaneously for 2-3 weeks to allow calculation of WOT PDA, and the 95% confidence interval (CI) was estimated using the bootstrap method with 10,000 samples. Sixty-one participants subsequently participated in an RCT to compare the proportion of prescribed doses confirmed by WOT and DOT. Participants were randomized 2:1 to receive WOT or maximal in-person DOT. In the WOT arm, if ingestions were not remotely confirmed, the participant was contacted within 24 hours by text or cell phone to provide support. The number of doses confirmed was collected, and nonparametric methods were used for group and individual comparisons to estimate the proportions of confirmed doses in each randomized arm with 95% CIs. Sensitivity analyses, not prespecified in the trial registration, were also performed, removing all nonworking (weekend and public holiday) and held-dose days. Participants, recruited from San Diego (SD) and Orange County (OC) Divisions of TB Control and Refugee Health, were 43.1 (range 18-80) years old, 57% male, 42% Asian, and 39% white with 49% Hispanic ethnicity. The PDA of WOT was 99.3% (CI 98.1; 100). Intent-to-treat (ITT) analysis within the RCT showed WOT confirmed 93% versus 63% DOT (p < 0.001) of daily doses prescribed. Secondary analysis removing all nonworking days (weekends and public holidays) and held doses from each arm showed WOT confirmed 95.6% versus 92.7% (p = 0.31); WOT was non-inferior to DOT (difference 2.8% CI [-1.8%, 9.1%]). One hundred percent of participants preferred using WOT. WOT associated adverse events were <10%, consisting of minor skin rash and pruritus associated with the patch. WOT provided longitudinal digital reporting in near real time, supporting patient self-management and allowing rapid remote identification of those who needed more support to maintain adherence. This study was conducted during the continuation phase of TB treatment, limiting its generalizability to the entire TB treatment course.Conclusions: In terms of accuracy, WOT was equivalent to DOT. WOT was superior to DOT in supporting confirmed daily adherence to TB medications during the continuation phase of TB treatment and was overwhelmingly preferred by participants. WOT should be tested in high-burden TB settings, where it may substantially support low- and middle-income country (LMIC) TB programs.Trial registration: ClinicalTrials.gov NCT01960257.

Dataset Information

Private patient perceptions about a public programme; what do private Indian tuberculosis patients really feel about directly observed treatment?

Publications

Private patient perceptions about a public programme; what do private Indian tuberculosis patients really feel about directly observed treatment?

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets