Trade, foreign policy, diplomacy and health

3. Tuberculosis control

Jim Yong Kim, Aaron Shakow, Arachu Castro, Chris Vande, Paul Farmer


TB control: DOTS (1)

As promoted by WHO, Directly Observed Therapy ('DOTS') has five elements:

  • Government commitment to control activities
  • Case detection by sputum smear microscopy
  • Standardized treatment regimens lasting at 6-8 months directly observed for 2 months
  • Regular, uninterrupted supply of anti-TB drugs
  • Standardised recording and reporting system

The key element in the control of TB is having health workers or volunteers form a close bond with their patients to help them successfully complete treatment. This practice, known as directly observed therapy (DOT), was first implemented in India in 1958. The DOTS (short course) strategy is and estimated to cost between $0.90 and $3.10 per year of life saved. As promoted by the WHO, 'DOTS' has five elements:

  • Government commitment to sustained TB control activities.
  • Case detection by sputum smear microscopy among symptomatic patients self-reporting to health services.
  • Standardized treatment regimens lasting at 6-8 months for all confirmed sputum smear- positive cases, directly observed for the initial 2 months.
  • A regular, uninterrupted supply of all essential anti-TB drugs.
  • A standardised recording and reporting system that allows assessment of treatment results for each patient and of the TB control program overall.
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