Direct Observed Treatment, Short-Course Strategy

The Directly Observed Treatment, Short-Course (DOTS) strategy has proven to be a highly effective and affordable strategy for controlling TB and is especially valuable in resource-poor settings. If implemented appropriately, DOTS has been shown to have an average success rate (cure and completion of treatment) of 80 percent and can also help prevent the emergence and spread of drug-resistant TB.

The DOTS strategy has six components, as outlined in The Stop TB Strategy [PDF, 299KB]:

• Pursue high-quality DOTS expansion and enhancement
• Address TB/HIV and MDR-TB and other special challenges
• Contribute to health system strengthening
• Engage all care providers
• Empower people with TB, and communities
• Enable and promote research

Implementing DOTS appropriately requires investments in: strengthened health systems including trained personnel; a functional system to procure, deliver, and manage a dependable supply of high quality TB drugs; and an effective monitoring and surveillance system.

USAID works in a limited number of priority countries in order to focus its resources, technical assistance, and staffing. Selection criteria for priority countries include:

• High incidence of TB (estimated incidence rates of over 100/100,000) and/or high number of total TB cases
• Significant HIV/AIDS prevalence
• Risk of escalating epidemics of multi-drug resistant TB
• Government commitment and technical and managerial capacity
• Capacity of USAID and other key TB partners
• Foreign policy considerations

Though USAID supports TB programs in more than 35 country and regional programs the following countries have been identified as priority countries for USAID.

• Expanded Country Programs. USAID is expanding efforts in the following countries to help scale up and strengthen the DOTS Strategy country-wide:
  Afghanistan, Bangladesh, Brazil, Cambodia, Democratic Republic of Congo, Ethiopia, India, Indonesia, Kenya, Mozambique, Nigeria, Pakistan, The Philippines, Russia, South Africa, Tanzania, Uganda, Ukraine, Zambia, and Zimbabwe.
  
  
• Countries with Targeted Interventions. USAID program efforts in the following countries focus on selected geographic coverage or addressing gaps in existing DOTS programs:
  Angola, Bolivia, Dominican Republic, Georgia, Ghana, Haiti, Honduras, Kazakhstan, Kyrgyzstan, Malawi, Mexico, Namibia, Peru, Senegal, Southern Sudan, Tajikistan, Turkmenistan, and Uzbekistan.

Stop TB Partnership