Review and Critique of the World Health Organization’s DOTS Programme: Recommendations to Improve Patient Compliance in the Treatment of TB and MDR TB in Low-resource Settings

Abstract

Tuberculosis, and its more serious forms, including Multi-drug Resistant Tuberculosis (MDR TB), represent serious health threats, especially in developing areas of the world such as India. Tuberculosis, including MDR TB represents a significant public health threat in the developing world. Present in more than 100 nations, it is estimated that there are greater than four hundred thousand new cases of MDR TB each year worldwide. With approximately 1.7 million deaths each year from MDR TB, TB and MDR TB are the leading cause of death for immunocompromised patients, such as those who are HIV positive. Treatment for all forms of TB is most successful in high income settings with adequate access to healthcare providers and sources of medication. However, most cases occur in resource poor settings, thus suggesting a need for further analysis of current DOTS programs to determine areas of potential improvement. The World Health Organization (WHO) currently recommends that treatment for TB as well as MDR TB involve a course of drugs which are directly administered to patients by healthcare professionals. However, there are several problems with this approach, as patients must often travel long distances to obtain the medicine away from their homes, work and family. This burden results in low adherence, and hence an increase in the number of cases of TB and MDR TB in these areas of the world. This review will look at alternatives to this approach that uses individuals from the community who are trained to administer the medications in the home community of the individual. Because these community health workers are part of the community they are trusted, and because they administer the medications locally, they remove the burdens of travel and time away from work for patients.