LAUREN Alimondo reported in October last year the 89 percent success rate of the tuberculosis treatment in the Cordillera region under the Department of Health’s (DOH) flagship program, the Directly Observed Treatment Short-course (Dots). That is, for those who completed the six-month treatment cycle, according to DOH officer Clint Gil Ildefonso.
Well, we hope that this success rate for Dots applies at least on the average around the country.
The problem, however, was and is compliance and adherence on the Dots medications, which the report seemed to assume accounts for the remaining 11 percent in failure rate. Evidently, these were all the information given by the DOH Cordillera office.
A study in 2008 of University of the Philippines-Manila’s Laurie Ramiro noted three factors of non-compliance and incomplete adherence.
First, non-compliant patients tended to delay taking their medications.
Second, these patients also tended to conclude too early that the medications worked, which caused them to stop their medications prematurely.
Third, non-compliance also resulted from less satisfaction with the patient’s treatment providers.
Also, there is a persistent attitude of “bahala na,” which tended to justify the patients taking the risk of not continuing with the medications.
There is, however, a flip side to this Dots success rate.
A multi-member team from multiple Philippine and U.S. agencies found out that resistance to anti-tuberculosis drugs had been detected in all regions in the country, comprising an estimated 8,500 cases of multi drug-resistant tuberculosis (MRT) cases in 2013 alone. The team was led by Thelma Tupasi of the Tropical Disease Foundation in Makati. Their report was published in 2016 in the Emerging Infectious Diseases journal. Twelve percent of these patients got their MRT infection during treatment.
It is clear then that the failure rate cannot be accounted solely by non-compliance or non-adherence. Treatment-caused MRT appears to be an unnoticed cause of Dots failure.
Nevertheless, the Dots program appeared to be largely successful. I know of two people who were cured through Dots. However, I knew also of a rural physician who told me about the emergence of MRT in his town as a result of Dots.
Is the 89 percent worth the risk despite the real consequence of MRT from the Dots program? The question is for the individual patient to answer.