DOTS Full Form

DOTS Directly Observed Treatment, Short Course, as the name suggests this is in-fact a directly observed treatment, short course of tuberculosis treatment, DOTS, is a strategy used to guide the treatment of pulmonary tuberculosis. It was first used in 1980. The DOTS strategy was developed by the World Health Organisation as a method of improving the effectiveness of tuberculosis treatment regimens. The strategy is based on the belief that tuberculosis treatment is better administered by health care providers who can observe the patient’s treatment adherence and who can offer follow-up and education if the patient does not adhere to the treatment protocol.

DOTS Directly Observed Treatment, Short Course is a course of treatment for TB patients that involves daily medication for a standard duration of 6 months, inpatient treatment, and a 6-month treatment outback after the inpatient treatment. The treatment is administered at clinics in rural areas where most of the estimated 4.5 million people with TB live. This course of treatment could be a solution for patients that are unable to take their medication because of the mild or high side effects.

Key Components of DOTS

DOTS is a highly successful model of in-patient tuberculosis treatment in a low-resource setting. When implemented correctly, the overall cure rate approaches 95%, even in the presence of extensive drug resistance. Some of the key components making DOTS successful include a) active case finding; b) drug-susceptible case management; c) direct observation; and d) strict patient follow-up. Other components of DOTS include – Treatment of non-susceptible and multi-drug resistant cases, Treatment of drug-susceptible cases, Treatment of latent infection. The key components of DOTS are stated below- 

1. Active case finding

Active case finding is essential to the success of a DOTS program. Active case finding involves testing individuals for disease every month and treating them according to their test results. It is critical to identify all individuals with active pulmonary TB and provide them with the necessary treatment. DOTS directly observed treatment, short course (DOTS-SC) is the form of treatment that is used in DOTS. 

 2. Drug- Susceptible Case Management

 Drug-susceptible case management is one of the key features of DOTS that makes it an outstanding model of case management. It involves the diagnosis and treatment of patients with drug-susceptible tuberculosis, regardless of the extent of their disease. In the absence of active transmission, diagnosing tuberculosis cases is usually straightforward and treatment is straightforward, even for those with extensive drug resistance. 

 3. Direct Observation

The keystone of DOTS is direct observation of patients taking their treatment. To ensure adherence to treatment, patients must be brought to a health care facility for their treatment. In DOTS, every eligible patient has a dedicated health care worker who follows them on a daily basis, including ensuring that they take and finish their treatment regimen. The other keystone of DOTS is that the patient is observed on each dose of their treatment, to ensure that they are implementing their recovery process for the safe prescribed period of time. 

 4. Strict Patient follow-up

Strict patient follow-up is another keystone of DOTS. Patients receive multiple visits once they have completed their treatment. On each visit, they are reviewed to ensure that they are recovering and no signs of TB are present. Once a patient completes their treatment, they are followed for at least six months, as they remain at risk for disease reactivation and the development of drug resistance. 

Goals of DOTS Tuberculosis prevention programme

The aims of DOTS tuberculosis control are to minimise mortality, morbidity, and disease transmission while preventing treatment resistance until the illness no longer constitutes a concern to public health. It also strives to alleviate human suffering as well as the social and economic burdens that families and communities must face as a result. To do this, it is vital to guarantee that every TB patient has access to diagnosis, treatment, and cure, as well as to safeguard vulnerable groups against TB and its drug-resistant variants. The most effective medication used in the DOTS therapy programme is according to the four drug regimen, they include Prazinamide, Ethambutol, Isoniazid, and Rifampicin.  

Conclusion

DOTS helps patients to achieve successful TB treatment outcomes by shortening treatment duration and improving its quality. Its success is based on the quality of care patients receive in the TB ward. By taking simple actions, we can improve patients’ treatment outcomes and therefore decrease TB transmission. DOTS is currently the most effective way to treat TB. In most countries with a high TB burden, more than 90 percent of TB cases are cured using DOTS. The two WHO-recommended DOTS regimens, daily regimens of two months for initial treatment of drug-susceptible TB and three months for initial treatment of multidrug resistant TB are the backbone of TB control.