DOTS

HEALTHCARE LESSON 5.4

FACTS ABOUT TB  Directly observed treatment with Short Course
 This disease is causing a financial loss amounting to  Chemotherapy (DOTS) of cases
7.9 billion pesos and an additional 27 billion from  Priority for treatment are smear (+) cases
indirect losses due to premature deaths and  Allocate drugs for whole duration of treatment
illnesses. It is estimated to rob workers of  Cohort Analysis
Php216/day for women and Php451 for men.
WHAT IS DOTS?
WAYS OF PREVENTING AND CONTROLLING TB  Proven cost effective TB treatment strategy
1. Prompt and effective treatment of patients  Adopted in 1991 by the WHO to control TB and in
2. Infection control measures in health care facilities: 1996 through its Global Tuberculosis Program (GTP)
Airborne precautions for hospitalized patients  Partnership with academic and scientific
3. Personal hygiene communities and other units of WHO
4. Immunization- BCG  Prevents the development of drug resistant strains of
5. Eradication of tuberculosis in cattle and the TB that are often fatal and almost 100 times more
pasteurization of milk will greatly reduce bovine expensive to cure
tuberculosis infection  most effective strategy for controlling TB today
 takes place in a health facility, treatment partner’s
NATIONAL TB CONTROL PROGRAM
house or the patient’s house
A. Treatment of all TB cases shall be based on reliable
 under DOTS, a TB patient is motivated to take his
diagnostic technique aside from clinical findings
drugs
B. Domiciliary treatment shall be the preferred mode of
 a treatment partner watches the patient take his
care.
drug daily, reports and traces the patient if he
C. Patients recommended for hospitalization are those
defaults, provide health education regularly and
with the following conditions:
motivates the patient on sputum follow-ups
1. massive hemoptysis
 health care workers, public health officials,
2. pleural effusion obliterating more than ½ of a
governments and communities must all share the
lung field
responsibility and provide a range of support
3. miliary TB
services patients need to continue and finish
4. TB meningitis
treatment
5. TB pneumonia
6. those requiring surgical intervention  treatment observer can be anyone who is willing,
7. those with complications trained, responsible, acceptable to the patient and
D. No patient shall initiate treatment unless the patient accountable to the TB control services
and health workers have agreed upon a case holding
mechanism for treatment compliance FIVE KEY COMPONENTS OF DOTS
E. The national and local government units shall ensure 1. Political commitment to sustain TB control activities
the provision of drugs to all sputum positive TB cases 2. Case detection by sputum smear microscopy among
Remember the target of the program are: symptomatic patients self-reporting to health
1. Increase Case Detection Rate (CDR) from 61% to services
70% or more 3. Standardized treatment regimen of 6 to 8 months for
2. Increase Cure Rate (CR) from 77% to 85% or at least all confirmed sputum smear positive cases,
more with DOTS for at least the initial 2 months
4. A regular, uninterrupted supply of all essential anti-
PROGRAM COMPONENTS TB drugs
5. A standardized recording and reporting system that
 Case Finding – diagnosis of TB Cases
allows assessment of treatment results for each
 Case Holding – supervised treatment of TB Cases
patient of the TB control program overall
 Support Activities
 Supervised treatment:
o Training
o cure TB patients and it can produce cure rates
o Supervision and Evaluation
as high as 95% even in the poorest countries
o Health Education
o prevent new infections among children and
o Recording and Reporting
adults
o can stop resistance to anti-TB drugs
PROGRAM POLICIES
o is cost-effective.
 Main diagnostic tool is sputum microscopy
 Three sputum specimens for examination and two
positive before declaring a TB case
 Quality control system of sputum microscopy ANTI-TB DRUGS
 Treat TB cases with at least three anti-TB drugs

YSABELLE R. CAGUIMBAL 1
 DOTS
HEALTHCARE LESSON 5.4

FURTHER EXPLORATIONS IN TB CONTROL

1. Allocation of funds to TB control
2. Adjustment to health sector reform that maintains
adequate TB control services
3. Workforce training and development with
appropriate compensation for health care workers
4. Government sense of TB as a national problem
5. Support and involvement of all health care workers
including physicians , nurses, pharmacist and medical
technologist utilizing a team approach in TB control
efforts
o development of new tools
o diagnosis
o treatment
o prevention
o preventive therapy in HIV- infected individuals
o mobilizing new partners

THE MEDICAL TECHNOLOGISTS AND THE DOTS

STRATEGY: A SHIFT OF PARADIGM
1. As change agents
2. As educators
3. As front liners
4. As research advocates
5. As treatment partners

YSABELLE R. CAGUIMBAL 2