TB control, poverty, and vulnerability in Delhi, India

Area of Science:

• Public Health
• Health Services Research
• Tuberculosis Control

Background:

• The Revised National Tuberculosis Control Programme (RNTCP), adopting the WHO's DOTS strategy, was implemented in India.
• Operational research was conducted in New Delhi from 1996-1998 to evaluate the RNTCP's early implementation.

Purpose of the Study:

• To assess the operational effectiveness and patient outcomes of the RNTCP in pilot sites.
• To identify challenges and potential inequities in tuberculosis treatment delivery.

Main Methods:

• Employed mixed-methods operational research, including interviews, focus groups, observations, and register data analysis.
• Evaluated cure and default rates within the RNTCP framework.

Main Results:

• Cure rates were 71% and 75%, with default rates of 6% and 11% in the pilot clinics.
• Health workers selectively enrolled patients based on perceived compliance and traceability, potentially excluding vulnerable groups.
• Patients facing poverty or social marginalization were often placed on older treatment regimens.

Conclusions:

• The RNTCP's target-driven approach, without sufficient support for health workers and patients, risked excluding the most vulnerable populations from optimal tuberculosis care.
• Operations research is crucial for identifying and addressing programmatic weaknesses in tuberculosis control efforts.