Adapting TB care in crisis: economic and post-covid changes in DOT practices in Colombo, Sri Lanaka

Abstract

Introduction: The World Health Organization recommends Directly Observed Therapy (DOT) for managing tuberculosis (TB). In Sri Lanka, TB is anticipated to rise following the economic crisis, particularly in urban Colombo. Since the COVID-19 pandemic, family members have been appointed as DOT providers. However, no study has evaluated DOT practices amid the economic crisis and transition to family-administered DOT. This study describes adherence to DOT practices and its associated factors among TB patients in Colombo. It is the first to assess DOT-related attitudes and practices in Sri Lanka and to identify barriers and facilitators to treatment.

Methodology: This descriptive cross-sectional study was conducted among 450 continuation phase patients of age ≥ 18 years registered at the Central Chest Clinic in Colombo. Data was collected via interviewer-administered questionnaire and chart review. Multivariate and regression analyses were performed, defining DOT compliance as having a DOT provider.

Results: Of 450 patients, 117 (26.0%) were DOT compliant, and most DOT non-compliant patients resorted to self-administered therapy. DOT status had no statistically significant effect on clinical outcomes, including sputum conversion, BMI, and missed doses. In multivariate analysis, male sex (OR 0.57) was most associated with non-compliance, while awareness of supervision requirements was associated with compliance (OR 3.77).    

Conclusion: As clinical outcomes were not significantly affected by DOT compliance status, SAT is a feasible DOT alternative in resource-limited settings if supported by adequate health education and socioeconomic support.