|Fact sheet No 104: Tuberculosis - Revised April 2000 (WHO, 2000, 3 p.)|
The WHO-recommended treatment strategy for detection and cure of TB is DOTS. DOTS combines five elements: political commitment, microscopy services, drug supplies, surveillance and monitoring systems and use of highly efficacious regimes with direct observation of treatment.
Once patients with infectious TB (bacilli visible in a sputum smear) have been identified using microscopy services, health and community workers and trained volunteers observe and record patients swallowing the full course of the correct dosage of anti-TB medicines (treatment lasts six to eight months). The most common anti-TB drugs are isoniazid, rifampicin, pyrazinamide, streptomycin and ethambutol.
Sputum smear testing is repeated after two months, to check progress, and again at the end of treatment. A recording and reporting system documents patients' progress throughout, and the final outcome of treatment.
· DOTS produces cure rates of up to 95 percent even in the poorest countries.
· DOTS prevents new infections by curing infectious patients.
· DOTS prevents the development of MDR-TB by ensuring the full course of treatment is followed.
· A six-month supply of drugs for DOTS costs US $11 per patient in some parts of the world. The World Bank has ranked the DOTS strategy as one of the "most cost-effective of all health interventions."
Since DOTS was introduced on a global scale, millions of infectious patients have received effective DOTS treatment. In half of China, cure rates among new cases are 96 percent. In Peru, widespread use of DOTS for more than five years has led to the successful treatment of 91 percent of cases.
By the end of 1998, all 22 of the high burden countries which bear 80% of the estimated incident cases had adopted DOTS. 43 percent of the global population had access to DOTS, double the fraction reported in 1995. In the same year, 21 percent of estimated TB patients received treatment under DOTS, also double the fraction reported in 1995.
WHO targets are to detect 70 percent of new infectious TB cases and to cure 85 percent of those detected. Six countries had achieved these targets in 1998. Governments, non-governmental organizations and civil society must continue to act to improve TB control if we are to reach these targets worldwide.
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