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Success Story
Anonymous treatment for TB patients improves recovery rate
A “Spot On” Treatment for Tuberculosis
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Photo: George Tsereteli
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A nurse dispenses TB drugs to a tuberculosis patient at a DOTS Spot treatment facility in Tbilisi.
Because of a USAID-sponsored TB treatment program called DOTS Spots, “direct observation” treatment in some areas has increased from 20 to 98 percent. The patients who received medication from DOTS Spots have fully completed the treatment regime and are finally cured of TB.
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A young woman living with her parents-in-law discovered that she contracted tuberculosis. But her husband’s parents did not want her to go to a TB dispensary where she could treat the disease. They did not want a nurse to come to deliver medication at home. They wanted to hide her condition from friends, family, and neighbors because of the social stigma associated with TB.
Once a deadly disease, TB has been treatable for 50 years. Yet in Georgia, issues such as social stigma prevent people with TB from seeking medical attention.
In 2003, USAID started a program to improve and expand TB treatment in Georgia, stressing the importance of an strategy known as DOTS that requires health professionals to directly observe patients take their medication. The DOTS strategy had been introduced in Georgia in the mid-1990s, with mixed results. Lack of training led to poor management and improvisation by health care professionals. Additionally, the program did little to address TB stigma. “I was often asked to meet patients in the streets, away from their homes, so they could hide the disease from their families and neighbors,” said Tiniko, a TB nurse. “If patients were not at home when I arrived, I had to leave the drugs with other family members or neighbors.” This made direct observation impossible and exacerbated the TB stigma problem.
USAID designed a solution that addressed both needs: administering direct observation and reducing social stigma. The program, “DOTS Spots,” brought TB-trained nurses to administer treatment in ordinary health clinics, not places reserved for TB patients. This helped resolve stigma-related problems and enabled the “direct observation” strategy critical to DOTS.
“Patients prefer coming to DOTS Spots because their anonymity is ensured,” said Tiniko. In Tbilisi, the capital, six DOTS Spots are already operational. Another two Spots will be set up in the Black Sea Port of Poti, starting a nationwide expansion program. DOTS Spots have helped regularize TB treatment, overcome stigma, ease the work of nurses, and increase treatment effectiveness. The approach is being replicated with the backing of the government, which has recognized that a simple and cost-effective intervention can result in a big success.
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