Directly Observed Therapy

DOTS redirects here. For the mathematical term, see Difference of two squares.

DOTS (directly observed treatment, short-course), is the name given to the World Health Organization-recommended tuberculosis control strategy that combines five components:

• 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 1990's, 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 short-hand toward promoting "Stop TB. Use Dots!" for health policy messages.^[1]

This contributed to a steady global uptake of DOTS TB control servies 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.^[2]

DOTS-Plus is for multi-drug-resistant tuberculosis (MDR-TB).

References

1. ^ [1]
2. ^ United Nations Millennium Development Goals Report 2011. 2011, p. 51.

• What is DOTS? A guide to Understanding the WHO-recommended TB Control Strategy Known as DOTS by World Health Organization 1999

• Pursue high-quality DOTS expansion and enhancement An explanation of the five components of DOTS and their role in the Stop TB Strategy organized by the World Health Organization 2010

• The politics of ‘branding’ in policy transfer The case of DOTS for tuberculosis control by Jessica Ogden, Gill Walt, Louisiana Lush, Social Science & Medicine 57, 2003, pp. 179–188

• The political causes and solutions of the current tuberculosis epidemic The Politics of Emerging and Resurgent Infectious Diseases by Jim Whitman, 2000, pp. 86-109

• What is DOTS? Joint Effort to Erradicate Tuberculosis

• WHO 2010/2011 TB Facts

External links

• DOTS program WHO - DOTS
• ACTION Advocacy to Control TB Internationally