Directly observed treatment, short-course (DOTS): ensuring cure of tuberculosis

The WHO-recommended strategy for tuberculosis control is known as DOTS (Directly Observed Treatment, Short-course). Of importance here are description of WHO recommendations for tuberculosis control, of the scientific basis for these recommendations, and of outcomes in areas which have implemented these recommendations. Standardized definitions and reporting formats allow for systematic analysis of the quality of diagnosis and treatment, including international comparisons. As of 1999, more than 110 countries are implementing the DOTS strategy. Quality of both diagnosis and treatment are markedly better than in previous programmes. In DOTS areas, a majority of adult patients have smear-confirmed disease. Nearly 8 out of 10 patients treated in DOTS areas completed treatment and had negative smears at the end of treatment. However, less than one fourth of tuberculosis patients globally undergo treatment consistent with the principles of DOTS. The DOTS strategy for tuberculosis control allows for standardized, accurate diagnosis and effective treatment. By curing infectious patients and thereby stopping tuberculosis at the source, DOTS protects children and communities from spread of the disease. DOTS policies for diagnosis and treatment are easily adaptable to a pediatric population. India and other countries are in the process of rapid expansion of the DOTS strategy. Constructive cooperation from all sectors will be required for success of the programme.