Self-administered TB treatment may work amid Sri Lanka crisis

Tuberculosis control typically uses Directly Observed Therapy (DOT), where a nominated person watches a patient take each dose. The World Health Organization recommends DOT, but Sri Lanka’s delivery of the approach has changed since the COVID-19 pandemic, with family members now often appointed as DOT providers. At the same time the country has endured an economic crisis that experts expect will increase TB, especially in the urban center of Colombo. Tara Alahakoon led the first study to evaluate how these shifts have affected DOT practice and patient attitudes in Sri Lanka. The research team set out to describe adherence to DOT and to identify barriers and facilitators to treatment under the current system. They focused on adults in the continuation phase of TB therapy registered at the Central Chest Clinic in Colombo to get a direct view of what patients were doing day to day, who was supervising medication, and how social and financial pressures might shape adherence. The aim was practical: to document current practices during a time of major social change and to point to what might help patients finish treatment successfully.

This descriptive cross-sectional study enrolled 450 continuation phase patients aged 18 years or older who were registered at the Central Chest Clinic in Colombo. Data were gathered using an interviewer-administered questionnaire and chart review, and the team used multivariate and regression analyses to explore links between patient characteristics and DOT practice. For this study, DOT compliance was defined as having a DOT provider. The investigators found that only 117 of 450 patients (26.0%) were DOT compliant; most DOT noncompliant patients resorted to self-administered therapy (SAT). Importantly, 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 included male sex, loss of income due to diagnosis, lack of physical disability, inadequate social support, and awareness of curability. At the same time, patients aware that a DOT provider is meant to help them take their medication were more likely to be compliant.

The findings suggest a pragmatic message for policymakers and clinicians operating under strain: when facility-based DOT is not attainable, supported self-administered therapy can be a feasible alternative if patients receive clear health education and socioeconomic support. The study highlights specific targets for support—men, people who lose income after diagnosis, and those with limited social support—while also pointing to the value of simple knowledge about the purpose of a DOT provider in boosting compliance. Because the research is cross-sectional and descriptive, it does not prove that SAT is always equal to DOT, but it does show that in this setting DOT status did not relate to key short-term clinical markers like sputum conversion, BMI change, or missed doses. In resource-limited circumstances intensified by an economic crisis and pandemic adaptations, expanding patient education and financial or social support could allow SAT to be used safely as part of TB control strategies in Colombo and similar settings.