New Delhi, March 24: India’s DOTS programme, specially designed to prevent people from skipping or giving up treatment of tuberculosis, lost track of more than 35,000 patients last year, government figures released today have revealed.

The DOTS (directly observed treatment short-course) programme, launched in India nine years ago, was aimed at ensuring that every tuberculosis patient completes the full six-month course of treatment typically involving four drugs.

It relies on a nationwide network of 12,000 laboratories, 261 medical colleges and 17,000 private practitioners to detect TB in sputum. An army of 200,000 DOTS providers are expected to watch the patients swallow tablets until the treatment is complete.

But the India TB 2008 report released by the health ministry shows that among 553,116 patients detected as sputum positive — thus potentially infective to others — and provided treatment in 2006, 6.4 per cent, or about 35,000 patients, defaulted on treatment.

“I’d be worried about even a single default, but this is too large a number to be ignored,” said Bobby John, president of Global Health Advocates, an international advocacy organisation.

Patients who stop treatment midway may develop drug-resistant TB, which is far more difficult and expensive to treat.

A defaulting patient may add to the drug resistance pool in the community, John said. Theoretical studies predict that a person with drug-resistant TB can infect up to 15 persons in the community each year.

A senior doctor associated with the DOTS programme said it had succeeded in reducing dropout rates from more than 30 per cent in the pre-DOTS era to about 6 per cent.

“DOTS was supposed to address non-compliance and dropout and it has done this,” the officer said, requesting not to be named. “But in such a large programme, we cannot eliminate dropouts.”

Health officials also said the DOTS programme has achieved a detection rate of 70 per cent, and treatment success rate of 86 per cent. India records about 1.7 million new cases of TB each year.

“The dropout number is worrying in one or two states, but this needs to be pursued with individual states,” the officer said. Goa has the highest proportion of dropouts of 16 per cent, although it had a relatively low number of patients — just 637.

However, among 19,749 sputum positive patients in Bihar, the DOTS programme lost 8.9 per cent — 1750 patients.

“These figures reflect a poor quality of DOTS programme delivery,” John said.

A TB Report Card released by Global Health Advocates today on the occasion of World TB Day has called for an increase in the number of microscopy centres for diagnosis and an increase in the number of DOTS providers so that people have to travel less distance for diagnosis and treatment.

“While there’s adequate supply of drugs now, people who are not feeling so sick after treatment for about two months probably just drop out,” said John.

In some places, the distance a person needs to travel for treatment could be 10-20km —thrice a week. “When a patient defaults, there’s not enough incentive for the DOTS provider to seek out the person who’s not continuing treatment.”

Last year’s India TB report also registered a 6 per cent default rate, with the actual numbers of patients lost by the DOTS programme thus at about 60,000.