Work

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

Year: 2025

Type: preprint

Abstract: Background The 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 country’s 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 country’s 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. Methods This descriptive cross-sectional study was conducted among 450 continuation phase patients of age ≥ 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. Results Of 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 (α < 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. Conclusion Provided 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.

Source: medRxiv

DOI: 10.1101/2025.09.15.25335789

Authors: Tara Alahakoon, Ravindu Jayaweera, Dasha Asienga, Amy S. Wagaman, Alexandra E. Purdy, Onali B.W. Rajapakshe

Institutions: Amherst College, University of Colombo, Ministry of Health, Nutrition and Indigenous Medicine

Language: English

Topic: Tuberculosis Research and Epidemiology

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funder: Amherst College