Assessment of Success Rate of Directly Observed Treatment Short-Course (DOTS) in Tuberculosis Patients of South India

Objective: To assess the success rate of DOTS for tuberculosis patients and the secondary objective was to identify the factors associated with unsuccessful treatment outcome. Methods: A retrospective study was conducted to review the medical records of patients (n = 1113) registered at the Directly Observed Treatment Short-Course (DOTS) clinic of Government Infectious Disease (Govt. ID) Hospital, Guntur, India. Multivariate logistic regression model was used to determine the factors associated with the treatment success rate. Results: The overall mean success rate of TB patients was found to be 82.8%. Treatment success rate (TSR) was steadily increased across the years from 73.9% in 2015 to 84.3% in 2016 and 88.9% in 2017 while the death rate was steadily decreased from 11.2% in 2015 to 6.25% in 2016 and 4.33% in 2017. Risk factors significantly associated with unsuccessful treatment outcome were found to be HIV positive (P<0.001), smear negative (P<0.001), all retreatment cases (P<0.001), smoking (P=0.008), and alcoholism (P=0.019). Smear positive patients had lower death rate (3.9% vs. 10.1%; P < 0.001) and failure rate ((2.6% vs. 8.7%; P < 0.001) compared to smear negative patients. Patients tested HIV positive had seen significantly unfavorable outcomes in death rate (OR= 9.17, 95% CI=5.31-15.83; P < 0.001) and treatment failure (OR=13.3, 95% CI= 7.31-24.17; P < 0.001). Conclusion: Implementing the DOTS strategy proved the satisfactory success rate in the South Indian hospital across three years. The unsuccessful treatment outcome was significantly associated with gender, HIV status, re-treatment, smear negative, smoking and alcoholism.