Directly Observed Therapy Shortcourse (DOTS) is an international protocol for handling infectious diseases, most commonly tuberculosis. DOTS therapy uses a battery of drugs in a prescribed order to eradicate tuberculosis and avoid the creation of drug-resistant strains of the disease. Drug-resistant tuberculosis began to emerge in the 1980s, and was recognized as a global public health risk. Drug resistant forms of the disease often appeared in response to incorrectly applied therapies, and the World Health Organization, in cooperation with other public health agencies, developed DOTS therapy, adopting it in 1991.
Patients undergoing this therapy will be observed while they take medication. Oversight may be provided by a medical professional or a non-medical professional like a family member. This observation helps ensure that the correct dosage of the drug is taken at the right time, and also that patients do not horde or sell their drugs. In many cases, DOTS therapy is used in a residential clinic environment, to be certain that patients do not vanish partway through treatment. The therapy is designed to be cost-effective, in recognition of limited public health budgets around the world. When used properly, a course of DOTS therapy cures over 80% of patients, striking a significant blow against tuberculosis world wide.
DOTS therapy has five elements, beginning with political commitment which must be accompanied by sustained, increased financial dedication. Many nations are struggling with rising tuberculosis rates, but DOTS therapy will only be an effective treatment if the nation is willing to follow through on treatment. The next step is improved case detection, which involves constructing high quality, reliable labs, as well as improving bacteriology techniques. The third element is standardized treatment, which goes hand in hand with better patient care and commitment. This therapy is only effective under supervision.
Step four is a reliable drug supply system. Drug-resistant tuberculosis can develop if patients are exposed to an unreliable drug source, especially one in which the types of drugs used vary. The DOTS course involves using the same tuberculosis medication throughout the therapy for maximum effect. Finally, the therapy incorporates an oversight system with periodic evaluation and measurement to determine how effective the therapy is.
The standardized DOTS system is used all over the world, from impoverished African nations to New York City, and it is hoped that DOTS will be a major player in the global elimination of tuberculosis. Because DOTS is used globally, success of DOTS programs can be easily compared, allowing nations which have not adopted the program to see the potential for success.