Directly Observed Treatment

The World Health Organization's directly observed treatment, short-course (DOTS) strategy involves training community health workers to increase awareness, detection, and treatment of TB and brings services directly to the homes of those at risk for infection. This strategy engages community-level volunteers in elements of TB service provision and is known to be one of the most cost-effective approaches to TB control.

In collaboration with international partners, ministers of health, district-level leaders, nongovernmental organizations, and community-based staff, MSH works to implement DOTS by:

  • Designing and managing national strategic plans for DOTS application, expansion, and sustainability
  • Developing and disseminating standard operation procedures for DOTS case detection and treatment
  • Recruiting and training community health workers to identify suspected cases of TB, provide DOTS, and refer patients in need of additional treatment to health facilities
  • Organizing and co-facilitating community-based TB awareness and stigma-reduction sessions
  • Strengthening national, district, and community-level DOTS recording and reporting systems

In the last two decades the world's largest cities have seen a surge in TB incidence, particularly in urban slums. MSH is implementing the DOTS strategy in densely populated, urban areas, which improves TB service delivery and involves health care providers in TB control efforts.

Our teams work alongside national TB programs and local stakeholders to train urban health facility staff to identify symptoms, provide timely testing and treatment, supervise patients' medication intake, and accurately register and report data. We also train these health workers to improve case detection by encouraging and facilitating testing for people living in close contact with TB patients.

  • In Ethiopia, through the HEAL TB project, MSH helped increase the proportion of health posts providing DOTS from 12 percent in 2011 to 41 percent in 2015.
  • In Uganda, through the TRACK TB project, MSH helped design an Urban DOTS model to support the Kampala Capital City Authority in providing quality TB care. Since its implementation, the number of TB service delivery health facilities has increased from 38 to 97 and the percentage of TB patients on DOT has increased 12-fold, surpassing the national target of 50 percent.
  • In Afghanistan, through the TB CAP and Challenge TB projects, MSH helped implement an Urban DOTS program in Kabul that improved TB case detection from 26 percent in 2009 to 60 percent in 2014. In that time, the treatment success rate among TB patients also rose, from 49 percent to 73 percent. The Urban DOTS program is now being expanded to three additional cities.