Trend in the incidence of smear-positive tuberculosis in a district in south India after DOTS implementation.

Subramani, R.; Gomathy, S.; Lakshmi, M.; Swaminathan, S.

International Journal of Tuberculosis and Lung Disease; 2016; 8; 1022-1026.   

Summary: Setting: One baseline and three repeat surveys of the prevalence of tuberculosis (TB) disease were conducted in 1999–2008 in rural South India , where the DOTS strategy was implemented in 1999. The impact of DOTS on prevalence was documented, but not its impact on incidence.

Objective: To ascertain epidemiological trends in the incidence of smear-positive TB.

Design: All persons aged ≥ 15 years (range 83000–92000) were examined using chest radiography (CXR); chest symptoms and history of anti-tuberculosis chemotherapy were noted in all four surveys. Sputum was collected from eligible participants and tested using direct smear and culture, and for drug susceptibility. As follow-up surveys were not frequent, survey cases and cases directly notified under DOTS were combined to estimate the incidence of smear-positive TB.

Results: Coverage was consistently high in all the repeat surveys, at ≥80% for CXR and symptom recording, and at =95% for sputum examination. The annual incidence of smear-positive TB was respectively 112, 80 and 76 per 100 000 population in 2001–2003, 2004–2006 and 2006–2008. The overall decline observed was 7.5% per annum.

Conclusion: A well-implemented DOTS strategy can lead to a reduction in the TB burden in the community.

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