DOTS was the Directly Observed Treatment Short course strategy. All countries with a TB problem were to provide standardized short course drug treatment to, at least, all sputum smear positive TB patients. Until 2. 00. 6 DOTS was to be the internationally recommended approach to global TB control. DOTS had five components which were initially as follows. Sustained political and financial commitment. Diagnosis of TB by quality ensured sputum smear microscopy. Standardized short course anti TB treatment (SCC) given under direct and supportive observation (DOTS). Los Angeles County Department of Public Health Tuberculosis Control Program 2615 S. Grand Avenue, Room 507 Los Angeles, CA 90007 Phone: (213) 745-0800 Fax: (213) 749-0926 Email: [email protected]. Wisconsin Tuberculosis Program. Tuberculosis, or TB, is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria can attack any part of the body, but usually attack the lungs. Tuberculosis (TB), WHO Global TB Programme: news, strategy, activities, data and publications on advancing universal access to tuberculosis prevention, care and control. Tuberculosis Program 1 2 – Tuberculosis Program December 2010. Directly Observed The following DOT requirements apply to the TB program. Therapy (DOT) DOT may be billed for TB-infected full-scope recipients as well. People presumed to be infected with INH or rifampin-resistant M.tuberculosis. Consult with your local TB control program about the management of such contacts. DOT should be considered for children of all ages. A regular uninterrupted supply of high quality anti TB drugs. Standardized recording and reporting. Upside down DOTS sign. In 1. 99. 6 the WHO claimed that “where the health system is working even moderately well, the DOTS strategy is extraordinarily effective achieving cure rates over 9. But where in sub- Saharan Africa were there TB programs reliably implementing all five parts of DOTS? There were certainly some places where DOTS was remarkably effective. In a nutshell The Problem: Tuberculosis is a treatable, infectious disease that is one of the leading causes of death for adults in the developing world. The Program: DOTS for TB consists of a) diagnosing cases, b) treating. Medical Diagnosis In the initial interviews with the patient, provide information about TB and the patient’s treatment plan. During DOT appointments and monthly monitoring, confirm and reinforce the patient’s understanding. For example, with the control of TB in China where the country achieved cure rates of more than 8. DOTS was not however the “magic bullet” it was thought to be, and a universal solution had not been found. However, the World Bank made support of TB programs contingent on the adoption of DOTS, and the “gospel” of DOTS spread far and wide. Five years after its emergence 1. DOTS. When it was first introduced DOTS did not take any account of HIV. In a 2. 00. 6 interview Arata Kochi the former director of TB programs at the WHO said: One thing that I didn’t do well is develop an additional strategy in addition to DOTS for HIV/TB. That is my regret. Multi drug resistant TBDOTS also did not take any account of drug resistant TB. Where resistance already exists to first line drugs such as isoniazid and rifampin, the DOTS program reverts to a short course of pyrazinamide and ethambutol. These are at doses insufficient to treat active TB, but in doses large enough to boost resistance. Further, if a patient’s TB was not cured, DOTS also called for retreatment with rifampin and isoniazid. So in these circumstances the DOTS programme could actually cause a worsening of the MDR TB situation. DOTS- Plus. In 1. WHO and their partners launched DOTS- Plus. Tuberculosis management refers to the. There are therefore calls for the private sector to engage in the public Revised National Tuberculosis Control Program that has proved. Author information: (1)Infectious Disease. DOTS remains at the heart of the Stop TB Strategy. The basic components of DOTS are described and discussed here. 3 Task Analysis - The basis for development of training in management of tuberculosis. DOT- Plus was to be developed as a comprehensive initiative that was to build upon the five elements of DOTS. However it would take into account specific issues such as the use of second line anti TB drugs, that needed to be used in resource limited settings where there were significant levels of MDR TB. This new approach of DOTS Plus needed rapid assessment of its feasibility and effectiveness under programme conditions. So in 2. 00. 0 the first DOTS- Plus pilot projects were launched and the Stop TB Working Group on DOTS- Plus for MDR- TB was also set up. One of the difficulties with the implementation of some of the DOTS- Plus pilot projects, was the need for quality second line anti TB drugs. These were normally very expensive and difficult to obtain. WHO and their partners made an arrangement with the pharmaceutical industry for preferential prices for the second line drugs used for the pilot projects. A ward for patients being treated under DOTS Plus. However, it was considered important that these beneficial prices were only used in projects that were organised according to certain standards. So the Green Light Committee was established to review project applications. They had to decide whether the applications were sufficiently in accordance with the guidelines that had been established for the pilot projects. If programs were approved the drug purchasing took place through the Global Drug Facility. By July 2. 00. 5 3. DOTS- Plus pilot projects had been established in 2. MDR- TB patients. With the ending of the piloting phase of DOTS- Plus it was believed that there was evidence that MDR- TB management was both feasible and effective in resource limited settings. With additional resources being available for MRD- TB control, there was then a rapid increase in the number of countries implementing DOTS- Plus. The Global Plan to Stop TB 2. So further international meetings were held, and a new declaration was the Amsterdam Declaration to Stop TB. The same goals were once again set, but this time to be achieved by 2. The Stop TB Partnership was set up in 2. Amsterdam Conference in 2. Initially the partnership comprised just six organisations. Three of its working groups were: DOTS Expansion. TB/HIVDOTS- Plus. By the time the first Stop TB Partners. At the Forum the launch took place of the Global Plan to Stop TB 2. Its aim was to provide a . This was not though a geographical expansion. This was effectively a redefinition of DOTS. In future DOTS would be about the provision of diagnosis, treatment and care for all patients. This would include those with drug resistant TB, and also patients co- infected with TB and HIV. Effectively DOTS Plus would no longer exist, as its various parts for drug resistant TB, and for TB/HIV co- infection were included in a redefined DOTS program. The Global Plan to Stop TB 2. This time it was the targets in the Global Plan to Stop TB 2. These targets had been considered realistic back when they were set in 2. In the new global plan for 2. Instead there were a range of targets covering specific areas such as the development of improved diagnostics and drugs, and the targets set in the Millenium Development Goals. The Global Plan to Stop TB 2. Many different areas were highlighted and in some, significant progress had been made, whereas in others, such as screening HIV positive people for TB, it was noted that much less progress had been made. It was particularly noted that the provision of funding for TB was an area of particular difficulty with a funding gap still existing of over US$1 billion per year. The Global Plan was subsequently updated in 2. Global Plan to Stop TB 2. Since then some action has been taken, but TB still claims one and a half million lives a year. More than 3. 0 million people have died since the global emergency was declared. What was said by WHO in 1. The disease, preventable and treatable, has been grossly neglected and no country is immune to it.
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