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World TB Day: DOTS and its 5 basic measures to deal with tuberculosis

Did you know tuberculosis can be completely treated with DOTS? Here's what you should know about this approach.

Written by Dr Anitha Anchan |Updated : March 24, 2017 6:38 PM IST

According to Press Information Bureau, tuberculosis in India continues to be the leading cause of death from communicable diseases. With 1,000 deaths per day or two persons succumbing to this deadly lung disease every three minute, 2.2 million TB cases occur in India every year. It is also estimated that there 3.5 million are sputum positive (presence of tuberculosis bacteria in sputum sample). However, with successful implementation of DOTS in India, there has been a significant rise in overall treatment rate. But before we get onto what is DOTS, here s what you need to know.

Completing the TB treatment course why is it important?

The symptoms of TB commonly resolve within few weeks of starting the treatment and many patients tend to discontinue their course of medication. However, you should not stop the treatment (even if you feel better), because the bacteria is still in your body and hence, the chances of recurrence is very high. Hence, completing your treatment course is of utmost important to cure tuberculosis completely. If you follow the full course of TB treatment, the disease can be treated (nearly 100%) in a span of 6 months. Patients who follow their TB treatment in an irregular and unreliable way are at an increased risk of treatment failure, relapse of the disease and development of multi-drug-resistant TB strains (which do not respond to standard TB drugs making it difficult and costly to treat tuberculosis).

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Whatis DOTS?

DOTS Directly Observed Treatment, Short-Course is the WHO-recommended strategy for tuberculosis control. It provides a definite cure for tuberculosis with a treatment course lasting from six to eight months. It is available free of cost to the patients in government hospitals in the whole nation. In India, the Revised National TB control programme (RNTCP) shifts the responsibility for cure from the patient to the health system. DOTS has been shown to prevent the occurrence of multi-drug resistant tuberculosis (MDRTB). It also reverses the trend of MDRTB in the suspected population and can cure TB even in HIV-positive patients.

The basic five components of the DOTS approach are -

#1 Political commitment

Starting from the national level to district level and even below, includes increased and sustained financing, legislation, planning, human resources, management and training necessary for success of the programme.

#2 Detecting cases through accurate diagnostictests

Sputum smear microscopy is used first followed by culture and drug susceptibility testing (DST). This remains the recommended method of TB case detection. Properly equipped laboratories with trained personnel are necessary to ensure this.

#3 Supervised treatment to ensure compliance

Standardized treatment procedures are followed all across the country for TB patients by following WHO guidelines on patient categorization and management. Supervised treatment -the core of the DOTS programme includes direct observation of therapy (DOT) wherein a patient takes the drugs directly in the presence of health workers or other trained persons. This helps patients to take their drugs regularly and complete treatment. Also read about what can happen if TB is not treated (complications of TB).

#4 An effective drug supply and management system

An uninterrupted and sustained supply of quality-assured drugs is essential to TB control which can be achieved by providing compulsory and free medicines to the patients.

#5 Monitoring and reporting

Continuous monitoring of the system is also essential to ensure the programme is successful. On an average, more than 1.25 lakh patients are treated every month under India s DOTS programme. Out of 531 districts, 446 districts are covered under National Tuberculosis Control Programme. 292 out of them are Short Course Chemotherapy (SCC) districts. SCC is a treatment given for a total period of six to eight months in two phases Intensive phase and Continuation phase. Anti-TB drugs include Streptomycin (S), Isoniazid (H), Ethambutol (E), Rifampicin (R) and Pyrazinamide (Z). You may also like to read about ways to prevent tuberculosis!

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