Doubts about DOTS

In 1993, the World Health Organization declared the tuberculosis epidemic a global emergency and responded with a new strategy to strengthen tuberculosis programmes dubbed “DOTS” (directly observed therapy short course).1 Two of the five components of DOTS aimed to promote the use of short course chemotherapy regimens based on rifampicin and to enhance adherence to treatment through directly observed therapy. One of the strategy’s key targets was raising the rate of treatment success at six months to at least 85%. Fifteen years later, WHO has made much of international progress towards this goal and of epidemiological projections suggesting that the tuberculosis crisis precipitated by coinfection with HIV may have peaked.2 In their accompanying paper, however, after reviewing evidence directly related to the treatment strategy approved by WHO, Cox and colleagues question whether DOTS is a suitable approach in all treatment settings.3

Debates about …