What is DOTS

DOTS (Directly Observed Treatment, Short Course) is the most effective strategy available for controlling tuberculosis. The WHO recommended DOTS strategy was launched formally as Revised National TB Control programme in India in 1997 after pilot testing from 1993-1996. Since then DOTS has been widely advocated and successfully applied. The success of DOTS lies in its five key components:

• Political commitment to control TB;

• Case detection by sputum smear microscopy examination among symptomatic patients;

• Patients are given anti- TB drugs under the direct observation of the health care provider/community DOT provider;

• Regular, uninterrupted supply of anti-TB drugs; and

• Systematic recording and reporting system that allows assessment of treatment results of each and every patient and of whole TB control programme.

The technical strategy for DOTS was developed by Karel Styblo of the International Union Against TB and Lung Disease in the 1970s and 80s, primarily in Tanzania, but also in Malawi, Nicaragua and Mozambique. Styblo refined, “a treatment system of checks and balances that provided high cure rates at a cost affordable for most developing countries.”

There has been a steady global uptake of DOTS TB control services over the subsequent decades. Whereas less than 2% of infectious TB patients were being detected and cured, with DOTS treatment services in 1990 approximately 60% have been benefitted 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 programs in 2009.

A systematic review of randomized clinical trials found no difference for cure rates as well as the treatment completion rates between directly observed therapy (DOT) 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).