The cure : DOTS (French)

DOTS (Directly Observed Treatment Short-Course)

The WHO-recommended treatment strategy for detection and cure of TB is DOTS.
DOTS combines five elements: political commitment, microscopy services, drug supplies, surveillance and monitoring systems and use of highly efficacious regimes with direct observation of treatment.

Once patients with infectious TB (bacilli visible in a sputum smear) have been identified using microscopy services, health and community workers and trained volunteers observe and record patients swallowing the full course of the correct dosage of anti-TB medicines (treatment lasts six to eight months). The most common anti-TB drugs are isoniazid, rifampicin, pyrazinamide, streptomycin and ethambutol.

Sputum smear testing is repeated after two months, to check progress, and again at the end of treatment. A recording and reporting system documents patients' progress throughout, and the final outcome of treatment.

• DOTS produces cure rates of up to 95 percent even in the poorest countries.

• DOTS prevents new infections by curing infectious patients.

• DOTS prevents the development of MDR-TB by ensuring the full course of treatment is followed.

• A six-month supply of drugs for DOTS costs US $11 per patient in some parts of the world. The World Bank has ranked the DOTS strategy as one of the "most cost-effective of all health interventions."

Since DOTS was introduced on a global scale, millions of infectious patients have received effective DOTS treatment. In half of China, cure rates among new cases are 96 percent. In Peru, widespread use of DOTS for more than five years has led to the successful treatment of 91 percent of cases.

DOTS has FIVE key components:

• Government commitment to sustained TB control activities.

• Case detection by sputum smear microscopy among symptomatic patients self-reporting to health services.

• Standardized treatment regimen of six to eight months for at least all sputum smear positive cases, with directly observed therapy (DOT) for at least the initial two months.

• A regular, uninterrupted supply of all essential anti-TB drugs.

• A standardized recording and reporting system that allows assessment of treatment results for each patient and of the TB control programme performance overall.

Government commitment to sustained TB control is ESSENTIAL for the other four components to be implemented and sustained. It is necessary for the mobilization of resources and the sustainability of TB programmes.

Sputum smear microscopy is the MOST COST-EFFECTIVE method of screening pulmonary TB suspects referring to health services. It identifies sputum smear positive, highly infectious TB cases.
TB is diagnosed using patient history, clinical examination and diagnostic tests. A sputum sample is submitted to the laboratory and the results of the microscopic exam are entered into the laboratory register. The goal is for all suspects to have a sputum smear microscopy exam and for all patients diagnosed with TB to be registered and treated.

Short-course chemotherapy refers to a PROCESS TREATMENT REGIMEN THAT LASTS SIX TO EIGHT MONTHS AND USES A COMBINATION OF POWERFUL ANTI-TB DRUGS. Standardized regimens are based on whether the patient is classified as a new case or a previously treated case.

Directly observed therapy (DOT) is ESSENTIAL AT LEAST DURING THE INTENSIVE PHASE OF TREATMENT (the first two months) to ensure that the drugs are taken in the right combinations and for the appropriate duration.
With direct observation of treatment, the patient doesn't bear the sole responsibility of adhering to treatment. Health care workers, public health officials, governments, and communities must all share the responsibility and provide a range of support services patients need to continue and finish treatment. One of the aims of EFFECTIVE TB CONTROL is to organize TB services which are integral part of health systems so that the patient has flexibility in where he or she receives treatment, for example in the home or at the workplace. Treatment observers can be anyone who is willing, trained, responsible, acceptable to the patient and accountable to the TB control services.

Where DOTS is implemented, an accurate recording and reporting system provides the information needed to plan and MAINTAIN ADEQUATE DRUG STOCKS.

The recording and reporting system is used to SYSTEMATICALLY EVALUATE PATIENT PROGRESS AND TREATMENT OUTCOME. The system consists of: a laboratory register that contains a log of all patients who have had a smear test done; patient treatment cards that detail the regular intake of medication and follow-up sputum examinations; the TB register, which lists patients starting treatment and monitors their individual and collective progress towards cure; and reporting forms from districts to the national level, which allow assessment of control efforts.