Improving the control ability of pulmonary tuberculosis with an internet based eDOTS system in the communities of Kashgar and Urumqi, Xinjiang of China

Background: Although the direct observed treatment strategy (DOTS) has been used for the control of pulmonary tuberculosis (PTB) in Xinjiang Uygur Autonomous Region for more than 30 years, the disease is still highly endemic in the region. To increase ability of PTB treatment and control efficacy, we developed a new eDOTS system for reminding, monitoring and educating PTB patients for regularly taking antibiotics. Methods: A total 167 new cases with active PTB from Kashgar villages and Urumqi City in Xinjiang were involved in the study. Among them, 81 patients were from villages with 43 patients using eDOTS system and 38 patients with traditional DOTS as control. Eighty six patients were from township with 50 patients using eDOTS and 36 patients using DOTS. Findings: PTB patients from villages in Kashgar treated with DOTS showed low compliance of taking antibiotics, only 27.9% the patients took medicine consistently once the network service for eDOTS system was removed. However, with the help of village and hospital doctors through the eDOTS system, the medical compliance were increased to 70-85%. The treatment compliance with eDOTS of patients from township (100%) was significantly higher than that of those patients from the rural villages (49%) in the first 6 weeks ( Χ 2 =33.3, P <0.01). DR X-ray Scores of PTB lesions showed that the patients using eDOTS either from the villages or from township significantly decreased their lesion score points compared to these scores from those patients using DOTS by 1.81 points，95% CI (0.72-2.90) and 1.05 points，95% CI (0.15-1.95) after 25 weeks of treatment, respectively. In the township, those 50 patients were looked after by one community doctor with eDOTS. Conclusion: eDOTS is an effective means of treating PTB patients in terms of reducing doctor’s work and increasing the compliance of taking antibiotics regularly during the treatment course. One doctor can easily look after 50 or more PTB patients through the eDOTS system. The constantly education program online through the system for the patients especially in villages plays an important role in encouraging TB patients taking antibiotics for a long period.