Facility-based directly observed therapy (DOT) for tuberculosis during COVID-19: A community perspective

Area of Science:

• Public Health
• Infectious Disease Management
• Global Health

Background:

• Facility-based directly observed therapy (DOT) has been the standard for tuberculosis (TB) treatment since the early 1990s.
• Growing emphasis on people-centered care models for TB necessitates re-evaluating traditional facility-based DOT due to concerns about freedom, privacy, and human rights.
• The COVID-19 pandemic accelerated the need for alternative TB treatment delivery methods.

Purpose of the Study:

• To investigate the challenges of administering facility-based DOT during a pandemic.
• To identify and evaluate potential alternative strategies for TB treatment delivery.
• To inform the development of more adaptable and patient-centered TB care approaches.

Main Methods:

• A global community-based survey was conducted.
• Quantitative and qualitative data were collected and analyzed.
• The study focused on the experiences of individuals undergoing TB treatment during pandemic-related disruptions.

Main Results:

• Barriers to facility-based DOT included reduced transportation access, COVID-19 fears, symptom-related stigma, and quarantine enforcement.
• These challenges were particularly pronounced in low-resource settings.
• Promising alternatives identified were community-based DOT, home treatment delivery, multi-month dispensing, and video DOT.

Conclusions:

• TB programs must reassess current treatment delivery methods to enhance accessibility and patient rights.
• Implementing alternative strategies like community-based DOT and remote care is essential.
• True people-centered TB care requires active consultation with individuals affected by TB and survivors.