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Implementing WHO DOTS strategy in the Russian Federation: stakeholder attitudes
Rifat A Atun1, Juan Baeza, Francis Drobniewski
1Centre for Health Management, Tanaka Business School, Imperial College London, South Kensington Campus, London SW7 2PG, UK. r.atun@imperial.ac.uk
Health Policy (Amsterdam, Netherlands)
|September 13, 2005
Summary
Russia faces a high tuberculosis burden. Stakeholders resisted Directly Observed Therapy--short course (DOTS) due to poor understanding and cultural factors, favoring traditional hospitalization for TB treatment.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Global Health
Background:
- Russia has the world's ninth highest tuberculosis (TB) burden, with case notification rates tripling in the 1990s.
- TB control practices in Russia historically diverged from the World Health Organization's (WHO) Directly Observed Therapy--short course (DOTS) strategy.
- DOTS coverage in Russia (26% in 2003) lagged significantly behind other high-burden countries (61%).
Purpose of the Study:
- To explore the attitudes of key stakeholders towards the introduction of DOTS in Russia.
- To identify barriers and facilitators for DOTS implementation in a Russian region.
Main Methods:
- Qualitative research approach utilizing six focus groups and 128 in-depth interviews.
- Participants included clinicians, managers, policymakers, and patients involved in TB control.
Main Results:
- Stakeholders exhibited negative attitudes towards DOTS adoption, citing inadequate understanding and perceived "directiveness" of the externally developed strategy.
- Traditional prolonged hospitalization for TB was favored for ensuring treatment adherence, access to medical expertise, and provision of basic needs (shelter, food).
- Concerns were raised about patient adherence to community-based treatment and potential impediments from cultural factors and capacity constraints (laboratory equipment, personnel).
Conclusions:
- Resistance to DOTS in Russia stems from a lack of understanding, cultural preferences for traditional care, and practical capacity limitations.
- Successful TB control in Russia may require adapting DOTS to local contexts or addressing stakeholder concerns regarding hospitalization and community adherence.