DOTS implementation in a post-war, United Nations-administered territory: lessons from Kosovo

Area of Science:

• Public Health
• Infectious Disease Control
• International Health

Background:

• The Directly Observed Treatment Short-course (DOTS) strategy is WHO-recommended for tuberculosis control.
• Limited evidence exists on DOTS implementation in post-war, transitional settings.
• Kosovo's health services underwent reorganization in 1999.

Purpose of the Study:

• To document the establishment of a National Tuberculosis Control Program (NTP) in Kosovo.
• To describe the implementation of the DOTS strategy from 1999-2005.
• To report the outcomes of this international collaboration in a post-war context.

Main Methods:

• A DOTS-based NTP was established in 1999 through international collaboration.
• Five key steps guided the NTP's operationalization.
• Data collected between 1999 and 2005 were analyzed.

Main Results:

• Kosovo met World Health Assembly targets for tuberculosis control.
• Achieved a 75% case detection rate for sputum smear-positive tuberculosis.
• Recorded a 93% treatment success rate.
• Observed a 44.5% decrease in new smear-positive tuberculosis case notifications (2000-2005).

Conclusions:

• Successful DOTS implementation in Kosovo demonstrates its effectiveness in post-war settings.
• International collaboration was crucial for the NTP's success.
• Formal guidelines for DOTS and STOP TB Strategy implementation in similar settings are recommended.