Tuberculosis (TB)

Table 3. Technical elements of the DOTS strategy

Case detection through quality-assured bacteriology

Case detection among symptomatic patients self-reporting to health services, using sputum smear microscopy. Sputum culture is also used for diagnosis in some countries, but direct sputum smear microscopy should still be performed for all suspected cases.

Standardized treatment with supervision and patient support

Standardized short-course chemotherapy using regimens of 6–8 months for at least all confirmed smear-positive cases. Good case management includes directly observed treatment (DOT) during the intensive phase for all new smear-positive cases, during the continuation phase of regimens containing rifampicin and during the entirety of a re-treatment regimen. In countries that have consistently documented high rates of treatment success, DOT may be reserved for a subset of patients, as long as cohort analysis of treatment results is provided to document the outcome of all cases.

An effective drug supply and management system

Establishment and maintenance of a system to supply all essential anti-TB drugs and to ensure no interruption in their availability.

Monitoring and evaluation system, and impact measurement

Establishment and maintenance of a standardized recording and reporting system, allowing assessment of treatment results (see Tables 4 5).