Directly Observed Therapy – Short Course
- DOTS redirects here. For the medical mnemonic, see DOTS (mnemonic).
- Government commitment (including both political will at all levels, and establishing a centralized and prioritized system of TB monitoring, recording and training)
- Case detection by sputum smear microscopy
- Standardized treatment regimen directly observed by a healthcare worker or community health worker for at least the first two months
- A regular drug supply
- A standardized recording and reporting system that allows assessment of treatment results
The technical strategy for DOTS was developed by Dr. Karel Styblo in the 1980s, primarily in Tanzania. In 1989, the World Health Organization and the World Bank began investigating the potential expansion of this strategy. In July 1990, the World Bank, under Richard Bumgarner's direction, invited Dr. Styblo and WHO to design a TB control project for China. By the end of 1991, this pilot project was achieving phenomenal results, more than doubling cure rates among TB patients. China soon extended this project to cover half the country.
During the early 1990s, WHO determined that of the nearly 700 different tasks involved in Dr. Styblo's system, only 100 of them were essential to run an effective TB control program. From this, WHO's relatively small TB Unit at that time, under Dr. Arata Kochi's leadership, developed an even more concise "Framework for TB Control" focusing on five elements and nine key operations. The emphasis was on "DOT, or directly observed therapy, using a specific combination of TB medicines known as short-course chemotherapy as one of the five essential elements for controlling TB.
In 1995, WHO developed a promotion strategy to brand this complex public health intervention. By marketing "DOTS" to global public health decision makers, turning the word "dots" upside down to spell "stop," proved an effective shorthand toward promoting "Stop TB. Use Dots!" for health policy messages.
This contributed to a steady global uptake of DOTS TB control services over the subsequent decade. Whereas less than 2% of infectious TB patients were being detected and cured from TB with DOTS treatment services in 1990, approximately 60% are now benefiting from this care. Since 1995, 41 million people have been successfully treated and up to 6 million lives saved through DOTS and the Stop TB Strategy. 5.8 million TB cases were notified through DOTS programmes in 2009.
A systematic review of randomized clinical trials found no difference for cure rates as well as the treatment completion rates between DOTS and self administered drug therapy. A 2013 meta-analysis of both clinical trials and observational studies too did not find any difference between DOTS and self-administered therapy. However the WHO and all other TB programs continue to use DOTS as an important strategy for TB delivery for fear of drug resistance .
DOTS-Plus is for multi-drug-resistant tuberculosis (MDR-TB).
||This article includes a list of references, but its sources remain unclear because it has insufficient inline citations. (March 2011)|
- United Nations Millennium Development Goals Report 2011. 2011, p. 51.
- Volmink, J; Garner P (2007). "Directly observed therapy for treating tuberculosis". The Cochrane database of systematic reviews. PMID 12535470.
- Pasipondya, JG; Gumbo T (2013). A meta-analysis of self-administered vs directly observed therapy effect on microbiologic failure, relapse, and acquired drug resistance in tuberculosis patients. PMID 23487389.
- What is DOTS? A guide to Understanding the WHO-recommended TB Control Strategy Known as DOTS by World Health Organization 1999
- DOTS for treating TB Volmink J, Garner P. Directly observed therapy for treating tuberculosis. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003343. DOI:10.1002/14651858.CD003343.pub3.