99DOTS has been launched in India to track adherence of TB/HIV co-infected patients
It is an initiative under TB-HIV coordination
Following measures have been introduced for the TB/HIV co-infected:
1. Provision of DAILY Anti-TB Treatment with Fixed Dose Combination instead of thrice weekly regimen and
• All patients with HIV associated TB will be initiated on daily ATT regimen instead of the current intermittent regimen. The daily regimen is preferred because the intermittent dosing schedules result in higher rates of treatment failure and relapse
2. Provision of Isoniazid Preventive Therapy (IPT) for PLHIV
Since there is now easy availability of Mobile phones, using communication technology can be a blessing for ensuring compliance and thus TB cure in TB/HIV co-infected patients.
99 DOTS is an approach for monitoring and improving TB medication adherence among TB/HIV co-infected.
99DOTS introduces antiTB blister pack wrapped in a custom envelope, which includes hidden phone numbers that are visible only when doses are dispensed.
After taking daily medication, patients make a toll-free call to the popped up phone number which is hidden till then, yielding high confidence that the dose was “in-hand” and has been taken.
The sequence of hidden numbers cannot be predicted by the patients, but is known only by the system for each blister pack prescribed. Hence one can be fairly confident that patients who respond correctly have indeed taken their medication
The ART Counsellor will ensure proper counseling of all the HIV-TB co-infected patients regarding adherence, usage of 99DOTS, and possible side effects of ATT
The District DR-TB & HIV-TB (Drug Resistant TB& HIV-TB) Coordinator is ultimately accountable for monitoring the adherence of all TB-HIV co-infected patients using 99DOTS.
The District DR-TB & HIV-TB Coordinator can login on the 99DOTS website using the district username and password.
The District DR-TB & HIV-TB Coordinator will link the patient to the correct TU by going to the patient’s individual page on the 99DOTS website. As soon as this is done, the field staff for that TU will start receiving SMS alerts for that patient’s adherence on a daily basis
Doing this will also enable the TU staff to access that patient on the 99DOTS website using their TU login and password.
In case of any missed doses (as seen on the 99DOTS website), he/she should arrange a phone call to the patient and make sure that the concerned field staff is following up with the patient. All such follow-up actions should be updated on the 99DOTS website as patient notes
All such follow-up actions should be updated on the 99DOTS website as patient notes. The 99DOTS website will also automatically flag patients as “HIGH attention” to make this easier.
References:
1. GOI 2016. Guidelines on Prevention and Management of TB in PLHIV at ART Centres. NACO, MoHFW, New Delhi
2. Oberoi, et al, 2016. 99 DOTS. International Journal of Contemporary Medical Research Volume 3, Issue 9 . September 2016; ICV: 50.43