Directly Observed Treatment Short-course (DOTS) strategy

The Directly Observed Treatment Short-course (DOTS) strategy is a globally recognized approach for the treatment and control of tuberculosis (TB).

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It was developed by the World Health Organization (WHO) in response to the global TB epidemic and has been endorsed by countries worldwide as the standard approach for TB care. The DOTS strategy is based on five key components, often referred to as the “DOTS” acronym:

1. Political Commitment: Political commitment at the highest levels of government is essential for the successful implementation of the DOTS strategy. Governments are encouraged to allocate adequate resources, establish supportive policies, and create intersectoral collaborations to strengthen TB control efforts.
2. Case Detection through Quality-Assured Microscopy: The DOTS strategy emphasizes the importance of timely and accurate diagnosis of TB cases through quality-assured microscopy. This involves the use of sputum smear microscopy, which is a simple and cost-effective diagnostic test for detecting TB bacilli in respiratory specimens.
3. Standardized Treatment with Supervision and Patient Support: Under the DOTS strategy, TB patients receive standardized treatment regimens consisting of multiple anti-TB drugs. Treatment is directly observed by a trained healthcare worker or community health worker to ensure adherence to the prescribed regimen and minimize the risk of treatment failure and drug resistance. In addition to supervision, patients receive comprehensive support services, including counseling, education, and assistance with social and economic needs.
4. Uninterrupted Supply of Quality-Assured Anti-TB Drugs: The DOTS strategy emphasizes the importance of ensuring uninterrupted access to quality-assured anti-TB drugs for all patients throughout the course of treatment. National TB programs are responsible for procuring, distributing, and monitoring the quality of anti-TB drugs to prevent stockouts, drug shortages, and the use of substandard medications.
5. Standardized Recording and Reporting Systems: The DOTS strategy requires the establishment of standardized recording and reporting systems to track TB cases, treatment outcomes, and program performance indicators. Health facilities and TB control programs are responsible for maintaining accurate records, reporting data to national TB registries, and conducting regular reviews and evaluations to monitor progress and identify areas for improvement.

In addition to these core components, the DOTS-Plus strategy was later introduced to address the management of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). DOTS-Plus builds upon the principles of the original DOTS strategy but includes additional components such as the use of second-line anti-TB drugs, individualized treatment regimens, and enhanced laboratory support for drug susceptibility testing.

Overall, the DOTS strategy has been instrumental in improving TB control efforts worldwide by increasing case detection, ensuring treatment adherence, reducing TB-related morbidity and mortality, and preventing the spread of drug-resistant strains of TB. Its success is attributed to its evidence-based approach, simplicity, and emphasis on community involvement and patient-centered care.