Economic crisis and post-COVID adaptations in Directly Observed Therapy practices among tuberculosis patients in Colombo, Sri Lanka: A cross-sectional study

BackgroundThe World Health Organization strongly recommends the Directly Observed Therapy (DOT) strategy in managing tuberculosis (TB). In Sri Lanka, TB is anticipated to rise following the countrys economic crisis, particularly in urban Colombo. Family members have been appointed as Directly Observed Treatment providers since the COVID-19 pandemic. However, no study has yet evaluated the current status of DOT practices in Sri Lanka as affected by the countrys economic crisis and transition to family-administered DOT services. The objective of this study is to describe adherence to DOT practices and factors associated with these practices among TB patients in Colombo under this current system. It is the first to determine attitudes and practices related to DOT in Sri Lanka, as well as to highlight barriers and facilitators to treatment among its TB patients. MethodsThis descriptive cross-sectional study was conducted among 450 continuation phase patients of age [&ge;] 18 years registered at the Central Chest Clinic in Colombo. Data was collected via an interviewer-administered questionnaire and chart review. Multivariate and regression analyses were performed, with DOT compliance defined as having a DOT provider. ResultsOf 450 patients, 117 (26.0%) patients were DOT compliant, and most DOT noncompliant patients resorted to self-administered therapy (SAT). Nevertheless, DOT or lack thereof had no statistically significant effect on clinical outcomes including sputum conversion, change in BMI, and missed doses. Factors associated ( < 0.05) with noncompliance were male sex, loss of income due to diagnosis, lack of physical disability, inadequate social support, and awareness of curability. Patients aware that a DOT provider is meant to help them take their medication were more likely to be compliant. ConclusionProvided sufficient health education and socioeconomic support, SAT may be a feasible DOT alternative in resource-limited circumstances in which facility-based DOT is not attainable.