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 40
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.
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