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Topic: Directly observed treatment

	Evaluation of a Directly Observed Therapy Short-Course Strategy for Treating Tuberculosis --- Orel Oblast, Russian ...
		This report summarizes evaluations of treatment outcomes for patients enrolled during the first 6 months of the project in Orel oblast and indicates that treatment success rates among TB patients in Orel were high.
		Treatment success (i.e., patients with bacteriologically documented cure and those who completed treatment) was attained for 88% of new and 60% of retreatment TB patients.
		The higher treatment success rates among Orel patients in whom asymptomatic TB was diagnosed using chest radiograph (without bacteriologic confirmation) compared with those with bacteriologic confirmation may reflect either early diagnosis of disease or incorrect diagnosis.
	www.cdc.gov /mmwr/preview/mmwrhtml/mm5011a3.htm (1278 words)

	JYI.org :: Letter to the Editor — The Dilemma of Tuberculosis Control and the DOTS Program (Site not responding. Last check: 2007-10-08)
		DOTS stands for Directly Observed Treatment Short course; it is a misnomer.
		Treatment therapy for eight months is not a ‘short course’; it is only a reduced course of treatment compared to the previous regimens of even longer duration.
		The DOTS program aims at controlling tuberculosis, not curing it, in sharp contrast to the well-known dictum, “Prevention is the best cure.” Tuberculosis is a disease of poverty, and it's often stated as an indicator of socioeconomic condition of the community.
	www.jyi.org /articletools/print.php?id=104 (1828 words)

	DOTS
		Since DOTS was introduced on a global scale, millions of TB patients have received medication and have been cured.
		DOTS works so well because it is a patient-centred approach, which provides support to TB patients by observing them as they swallow their TB drugs and ensuring that they complete the treatment.
		The person monitoring the TB patient must be prepared to observe and record the fact that the patient has taken the correct dose of their medicine.
	library.thinkquest.org /C0126375/dots.htm (367 words)

	BioMed Central \| Full text \| DOTS improves treatment outcomes and service coverage for tuberculosis in South Ethiopia: ...
		The aim of the study was to assess trends in the expansion of DOTS and treatment outcomes for tuberculosis in Hadiya zone in Southern Ethiopia.
		DOTS is equally effective in curing TB patients with HIV co-infection [9,12] and hence, its importance in the era of the HIV/AIDS epidemic.
		DOTS was initiated in 1996 in a hospital and one health centre, with potential population coverage of 25% (defined as population living within 2 hours walking distance from a health facility; estimated at 250,000 for the hospital and 25000 for the health centre).
	www.biomedcentral.com /1471-2458/5/62 (4273 words)

	Cost Effectiveness and Resource Allocation \| Full text \| Cost and cost-effectiveness of community based and health ...
		The conventional (health facility based DOT) approach to tuberculosis control in Tanzania presupposes initial diagnosis and treatment of patients on ambulatory basis, provided the patients are strong enough to follow their medication and are free from complications that need hospital care[11].
		Estimates of cure rate that would apply without treatment (null intervention scenario) was calculated assuming a self cure rate of 20% in the absence of treatment for individuals who are not otherwise immuno-compromised, and a self cure rate of 0% for those who are HIV+[13,18].
		Treatment success rates among patients under community and health facility based DOT were 85 %(221 patients) and 83 %(271 patients) respectively (OR 1.17, 95% CI 0.75–1.83) [6].
	www.resource-allocation.com /content/3/1/6 (5029 words)

	witb-trmt (Site not responding. Last check: 2007-10-08)
		Many times a person infected with tuberculosis gets the treatment and yet do not continue it for the right amount of time (sometimes it can be as long as six months).
		Directly observed treatment short-course is the name for a comprehensive strategy which primary health services around the world are using to detect and cure tuberculosis.
		TB treatment takes at least six months to complete and often patients stop taking their medicine because they feel better.
	library.thinkquest.org /26160/witb-trmt.html (280 words)

	Directly Observed Therapy for Tuberculosis
		Furthermore, the authors contend that directly observed treatment does not often use confinement to motivate patients to comply; rather, they point out that incentives and enablers are more commonly used.
		In response, Heymann, of the Harvard School of Public Health, and others note that directly observed therapy is not necessary for TB-incidence reduction, as evidenced by the decline in U.S. TB cases between 1953 and 1985, when the practice was not used.
		The authors state that the findings indicate that TB treatment programs should be developed to better serve patients, and they do not to discourage them from seeking care, either with directly observed therapy or self-administered treatment.
	www.aegis.com /news/ads/1999/ad990534.html (577 words)

	The Primary Health Care Package for South Africa - a set of norms and standards
		Achieve a minimum community-based directly observed tuberculosis treatment cure rate of new sputum positive TB cases of 85%.
		DOTS supporters for TB cases are as near to the home of cases as is convenient to ensure regular treatment and periodic clinic supervision.
		DOTS supporters in the community receive supportive supervision by regular contact with the clinic nurse who will also record continuity of progress in the clinic TB register.
	www.doh.gov.za /docs/policy/norms/part2b.html (323 words)

	Directly Observed Therapy : Bureau of Tuberculosis Control : NYC DOHMH
		Directly Observed Therapy (DOT) is the standard of care for tuberculosis (TB) treatment.1 In directly observed therapy, a trained health care worker monitors the patient taking each dose of anti-tuberculosis medication.
		For fully drug-susceptible TB, treatment given two or three times per week by DOT is at least as effective as daily treatment.
		The effect of directly observed therapy on the rates of drug resistance and relapse in tuberculosis.
	www.ci.nyc.ny.us /html/doh/html/tb/tb2a.shtml (651 words)

	India Comes up with Easier Cure for TB
		Since the 1990s, DOTS has been the cornerstone of a fight against an ancient disease that seems to have suddenly gained resurgence partly due to the development of resistance by the concerned bacterium to common antibiotics.
		DOTS is designed to carefully monitor each patient's progress while being treated with a potent combination of isoniazid, rifampicin, pyrazinamide and ethambutol for a minimum of six months or a complete certifiable cure is achieved.
		From 18 to 24 months when TB treatment first became available in the 1950s, clinical trials in India and other parts of the world have helped to gradually shorten the duration first to 12 months, then nine months and finally six months.
	www.aegis.com /news/ips/2002/IP020808.html (1053 words)

	Tuberculosis in India:Diagnosis,treatment,control,TB and HIV
		Dwelling on the WHO recommended Directly observed Short Course Treatment Dr.Pradhan said NGOs like the TB association of India and the state TB associations must be included to ensure the success of the programme.He requested the central Govt to waive all taxes on anti tubercular drugs.
		When the controlled for homelessness, HIV status, and directly observed therapy, the relative risk of MDR-TB was calculated to be 8.6 (confidence interval, 3.1 to 23.6) in the diabetic group compared to the control group.
		Bhalla says the observation that the knowledge regarding the treatment guidelines among the residents and consultants is low points to the fact that reeducation of faculty members regarding recent trends or guidelines is essential if we want this knowledge to percolate to the periphery.
	www.angelfire.com /indie/tbindia/journalscan.html (1289 words)

	Better drugs and treatment (Site not responding. Last check: 2007-10-08)
		To improve adherence to the lengthy regimen imposed by existing TB medicines, a practice was instituted internationally a decade ago, whereby healthcare workers directly observe patients taking their medications.
		DOTS is extremely effective, but it only reaches 27% of TB patients worldwide.
		Since a majority of costs for TB treatment are non-drug related, a shorter therapy would eliminate many such costs and redirect spending to basic health expenses.
	www.tballiance.org /2_2_C_BetterDrugsTreatment.asp (361 words)

	MSF Access Website \| The Campaign \| Target Diseases \| Tuberculosis (Site not responding. Last check: 2007-10-08)
		However, the length and complexity of this treatment mean that many patients interrupt or abandon the course of drugs before the end.
		However, DOTS is long and intensive: it lasts 6-8 months and requires each patient to swallow the drugs in front of a health worker every day for at least the first two months.
		DOTS can be a heavy burden on already struggling health services, and is often too expensive to implement for developing countries.
	www.accessmed-msf.org /campaign/tb01.shtm (1165 words)

	PSI: News
		By adding TB screening and branded Directly Observed Treatment (DOTS) to the services and products offered through PSI/Myanmar's Sun Quality Health (SQH) network of private clinics, and motivating those at risk to get tested and treated, Myanmar is blazing a path not only for PSI but for other TB implementers and donors.
		DOTS is recommended by WHO as the most effective strategy for combating TB, and has gained significant international acceptance and practice.
		DOTS has proven highly effective in curing TB, preventing the emergence of drug-resistant TB and preventing new infections.
	www.psi.org /news/1004g.html (534 words)

	Treatment of T.B.
		Rather the problem is lack of organization of services to ensure widespread detection and cure of T.B. To solve this problem, the treatment of T.B. is now modified to DOTS i.e.
		1- Directly observed treatment means medicine to the patient should be given in front of some medicinal personnel.
		It is an important feature of DOTS covering a population of 100,000 to 150,000.
	www.angelfire.com /falcon/emed/D.O.T.S.htm (720 words)

	Pitfalls of tuberculosis programmes in prisons (Site not responding. Last check: 2007-10-08)
		Directly observed therapy is designed to ensure, by means of direct observation, that patients actually take their full course of treatment.
		The guerillas turned out to be very cooperative: as soon as their internal, quasimilitary, hierarchy had understood the reasons for complying with treatment, clear orders were given to all members of the group, and their compliance rate was close to 100%.
		Directly observed therapy was implemented inside the prisons, supervision ensured by expatriate nurses.
	www.icrc.org /Web/Eng/siteeng0.nsf/html/57JP2Y (2957 words)

	TB Bill summary (Site not responding. Last check: 2007-10-08)
		Multi-drug resistant tuberculosis is caused by incorrect or incomplete treatment: where patients do not take all of their medicines regularly for the required period, doctors and health workers prescribe the wrong drugs or the wrong combination of drugs, or the drug supply is unreliable.
		In the U.S., TB treatment, normally about $2,000 per patient, skyrockets to as much as $250,000 per patient to treat MDR-TB, and treatment may not even be successful.
		Based on World Bank estimates DOTS treatment is one of the most cost-effective health interventions available-costing just $20-$100 to save a life.
	www.oberlin.edu /staff/agallahe/Results/TB_bill_summary_000314.html (496 words)

	Red Cross Red Crescent - Facts about Tuberculosis
		Directly Observed Treatment, Short-course (DOTS) is the most effective strategy available for controlling the TB epidemic today.
		Standardised treatment regime of six to eight months for all people who test positive, including directly observed therapy for at least the first two months.
		Incomplete treatment of TB can lead to the development of bacteria that are resistant to the drugs most commonly used.
	www.ifrc.org /what/health/diseases/tb/facts.asp (405 words)

	CDC - Children and Multidrug-Resistant Tuberculosis in Mumbai (Bombay), India
		Directly observed treatment strategy is not followed in the general outpatient clinics. Hence, compliance with treatment depends on the motivation and perseverance of the parents.
		We suggest that this case is not unusual and that many children in Mumbai are dying of multidrug-resistant TB because directly observed treatment strategy regimens are unavailable.
		Treatment of tuberculosis by private general practitioners in India.
	www.cdc.gov /ncidod/EiD/vol8no11/02-0513.htm (1386 words)

	Evidence Based Medicine
		Directly observed treatment refers to the practice of giving patients their pills and seeing that they are swallowed(1).
		Even though directly observed therapy (DOT) is widely advocated as the most cost-effective means of ensuring completion of TB treatment, no completed trials could be found which confirm or refute this view.
		Treatment of tuberculosis and tuberculosis infection in adults and children.
	www.indianpediatrics.net /dec-99/99-dec-19.htm (632 words)

	CID at Harvard University :: WORLD IGNORES TUBERCULOSIS AT ITS PERIL, Boston Globe, 7/9/01
		To combat the new menace, the World Health Organization adopted a "directly observed treatment strategy," or DOTS, in which patients would be given second-line drugs when their disease became resistant to first-line drugs.
		The drug treatment would be directly observed by a health worker to make sure the medicine was in fact taken according to schedule.
		If the directly observed treatment strategies are not maintained in a serious way, the future may see a drug-resistant TB defying all known antibiotics.
	www.ksg.harvard.edu /cid/cidinthenews/articles/Globe_070901.html (665 words)

	Directly observed treatment for tuberculosis -- Garner and Volmink 327 (7419): 823 -- BMJ
		Directly observed treatment for tuberculosis -- Garner and Volmink 327 (7419): 823 -- BMJ
		Volmink J, Garner P. Directly observed therapy for treating tuberculosis.
		Chaulk CP, Kazandjian VA. Directly observed therapy for treatment completion of pulmonary tuberculosis: Consensus statement of the public health tuberculosis guidelines panel.
	www.bmj.com /cgi/content/full/327/7419/823 (793 words)

	Children and multidrug-resistant tuberculosis in Mumbai , India - Bombay - Letters - Letter to the Editor Emerging ...
		Since most families cannot afford antiretroviral therapy, HIV-infected children in whom TB is diagnosed are prescribed a four-drug TB treatment (consisting of isoniazid, rifampicin, pyrazinamide, and ethambutol) and co-trimoxazole for Pneumocystis carinii pneumonia prophylaxis.
		Directly observed treatment strategy is not followed in the general outpatient clinics.
		Hence, compliance with treatment depends on the motivation and perseverance of the parents.
	www.findarticles.com /p/articles/mi_m0GVK/is_11_8/ai_94593129 (990 words)

	Doctors Without Borders: Life in the Field
		The best available treatment for TB requires a rigorous four-month course of daily medication that has to be directly observed by health workers.
		The Kenyan treatment regime MSF uses, known as “manyatta,” was specifically designed for nomads, and requires a four-month course of medicine instead of the standard six months.
		If better TB drugs were developed, four to eight months of directly observed treatment might not be necessary, allowing migrant people to be treated all at once or take their medication with them.
	www.doctorswithoutborders.org /ng/ep8/ep8_region.html (551 words)

	CNN - Tuberculosis 'breakthrough' debated - Mar. 19, 1997
		Nevertheless, WHO said the global tuberculosis epidemic is leveling off for the first time in decades because of the treatment strategy, which puts trained monitors in charge of making sure TB patients take their medication.
		But Russia and other former Soviet bloc countries, which have yet to fully adopt the "directly observed treatment" method, have seen a TB explosion in recent years that threatens all of Europe, WHO officials said.
		DOTS combines a multi-drug treatment with a health management system that WHO claims is virtually certain to cure every TB patient treated.
	www.cnn.com /HEALTH/9703/19/tuberculosis (620 words)

	PSI: DOTS
		standardized six-month treatment regimen, in which the treatment is directly observed for at least the first two months
		DOTS has proven highly effective in curing TB, preventing the emergence of drug resistant TB, and preventing new TB infections.
		Treatment completion is essential to avoid transmission, multi-drug resistant TB, and death.
	www.psi.org /our_programs/products/dots.html (424 words)

	Directly Observed TB Treatment Cuts Death Rate Sevenfold In India - Your Pulmonology Community� (Site not responding. Last check: 2007-10-08)
		NEW DELHI, Mar 27 (Reuters Health) - Only one out of eight tuberculosis patients in Southeast Asia is receiving treatment under the improved TB control strategy of DOTS (directly observed treatment, short course), according to the World Health Organization on the occasion of World Tuberculosis Day last Friday (March 24).
		An international review of DOTS in India last month revealed that it had cut the death rates due to TB by seven times--achieving cure rates of more than 80%.
		The rapid spread of HIV and the emergence of multidrug-resistant TB have the potential to severely jeopardize progress in the future if current efforts are not rapidly intensified and accelerated, warns the WHO.
	www.pulmonologychannel.com /PulmonologyWorld/directly.shtml (408 words)

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