DOTS & DOT

Outpatient department of Center for TB and Lung diseases of Riga East Clinical

hospital

Inga Lepse

DOTS – strategy for TB control

WHO recommends a Strategy

for TB control called DOTS

(Directly Observed Treatment, Short – course)

DOTS comprises 5 components

• Sustained political and financial commitment

• Diagnosis by quality ensured sputum – smear microscopy (passive case detection)

• Standardized short – course TB treatment given under direct and supportive observation

• Regular, uninterrupted, supply of anti-TB drugs

• Standardized recording and reporting

DOT

D-irectly

O-bserved

T-reatment

DOT • DOT by definition means watching patient

swallow each dose of anti-TB drugs

• Patients are supervised while medication is administered

• Implementation in Latvia – started in 1996

• It has been effective in controlling the spread of TB

TB Treatment • Long term

(6 – 9 months for susceptible TB;

18 – 24 months for MR TB);

• Drug combinations

• Under supervision

Why DOTS? • People can have problems taking medications

correctly

• Helps patient finish TB therapy as quickly as possible

• Helps prevent TB from spreading to others

• Decreases the risk of drug-resistance resulting from incomplete treatment

DOT includes

• Delivering the prescribed medication

• Checking for side effects

• Watching the patient swallow the medication

• Documenting the visit

• Answering questions

Tasks Involved in Delivering DOT

• Verify medication

• Check for side effects

• Watch patient take pills

• Document the visit

DOT providers

• Nurses

• Family doctors & nurses

• Trained healthcare workers

Excluding family members!

Clinic-based DOT

• TB hospital

• TB out patient department

• Family doctor

• General hospital

Field based DOT

• The patient's home

• The patient's workplace

• School, kindergarten

• Shelter

• Public park or other agreed-upon public location

• Restaurant

Advantages of DOT • It ensures that the patient completes an

adequate regimen

• It lets the health care worker monitor the patient regularly for side effects and response to therapy

• It helps the health care worker solve problems that might interrupt treatment

• By ensuring the patient takes every dose of medicine, it helps the patient become noninfectious sooner

Disadvantages of DOT

• Is time consuming

• Is labor intensive

• Can be insulting to some patients

• Can imply that the patient is incapable or irresponsible

• Can be perceived as demeaning or punitive