Barriers of Treatment-Supporters for DOTS under RNTCP in District Shahdol, India: A Mix-Method Study

Background: One of the challenges of Revised National Tuberculosis Control Programme (RNTCP) has been that it has not been able to impart adequate knowledge, satisfactory attitude and desirable practices among treatment-supporters of rural and tribal communities. Present study was planned to explore the knowledge, attitude, practice and perceived barriers related to Directly Observed treatment (DOT) provision among the treatment-supporters of Shahdol district, Madhya Pradesh in 2018. Methods: Mixed–methods study design of triangulation type was used among 30 community- based treatment-supporters of DOT from Sohagpur tahsil of district Shahdol of Madhya Pradesh, India. The cross-sectional quantitative component assessed the knowledge, attitude and practices and three focus-group discussions were used to explore the perceived barriers related to DOT provision. Results: ‘Adequate knowledge’ related to DOT provision was found in 37% of treatment- supporters, while 40% had “satisfactory attitude” and 60 % had “satisfactory practice” related to DOT. The focus-group discussions revealed, ineffective training, lack of supportive supervision, insecure monetary incentive, distant Public Health Institution/Designated Microscopic Center, language barrier and patient related stigma to TB disease as main perceive challenges related to DOT. Conclusion: Study revealed inadequate knowledge and unsatisfactory attitude and practice related to DOT provision among treatment-supporters. Effective training, making services accessible to patient, making RNTCP form in Hindi language and strengthening of honorarium disbursement mechanism are urgently required.