Directly observed treatment
Encyclopedia
DOTS is the name given to the World Health Organization
-recommended tuberculosis
control strategy that combines five components:
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.
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.
DOTS-Plus is for multi-drug-resistant tuberculosis
(MDR-TB).
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
-recommended tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
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 smearSputum cultureA sputum culture is a test to detect and identify bacteria or fungi that infect the lungs or breathing passages. Sputum is a thick fluid produced in the lungs and in the adjacent airways. A sample of sputum is placed in a sterile container and sent to the laboratory for testing...
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
World Bank
The World Bank is an international financial institution that provides loans to developing countries for capital programmes.The World Bank's official goal is the reduction of poverty...
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
Arata Kochi
is a Japanese physician and public health expert, who is the former director of the World Health Organization's malaria program. He had previously been director of WHO's tuberculosis programs for ten years. While at WHO, Dr...
'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.
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.
DOTS-Plus is for multi-drug-resistant tuberculosis
Multi-drug-resistant tuberculosis
Multi-drug-resistant tuberculosis is defined as TB that is resistant at least to isoniazid and rifampicin , the two most powerful first-line anti-TB drugs...
(MDR-TB).
External links
- DOTS program WHO - DOTS
- ACTION Advocacy to Control TB Internationally