Has the DOTS strategy improved case finding or treatment success? An empirical assessment.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: Electronic Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Directly Observed Therapy*; Anti-HIV Agents/*therapeutic use ; Antitubercular Agents/*therapeutic use ; HIV Infections/*prevention & control ; Tuberculosis, Pulmonary/*prevention & control; Cohort Studies ; Cross-Sectional Studies ; HIV Infections/diagnosis ; HIV Infections/epidemiology ; Humans ; Treatment Outcome ; Tuberculosis, Pulmonary/diagnosis ; Tuberculosis, Pulmonary/epidemiology ; World Health Organization

Background: Nearly fifteen years after the start of WHO's DOTS strategy, tuberculosis remains a major global health problem. Given the lack of empirical evidence that DOTS reduces tuberculosis burden, considerable debate has arisen about its place in the future of global tuberculosis control efforts. An independent evaluation of DOTS, one of the most widely-implemented and longest-running interventions in global health, is a prerequisite for meaningful improvements to tuberculosis control efforts, including WHO's new Stop TB Strategy. We investigate the impact of the expansion of the DOTS strategy on tuberculosis case finding and treatment success, using only empirical data.
Methods and Findings: We study the effect of DOTS using time-series cross-sectional methods. We first estimate the impact of DOTS expansion on case detection, using reported case notification data and controlling for other determinants of change in notifications, including HIV prevalence, GDP, and country-specific effects. We then estimate the effect of DOTS expansion on treatment success. DOTS programme variables had no statistically significant impact on case detection in a wide range of models and specifications. DOTS population coverage had a significant effect on overall treatment success rates, such that countries with full DOTS coverage benefit from at least an 18% increase in treatment success (95% CI: 5-31%).
Conclusions: The DOTS technical package improved overall treatment success. By contrast, DOTS expansion had no effect on case detection. This finding is less optimistic than previous analyses. Better epidemiological and programme data would facilitate future monitoring and evaluation efforts.

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0 (Anti-HIV Agents)
0 (Antitubercular Agents)

Date Created: 20080306 Date Completed: 20080626 Latest Revision: 20240607

20240607

PMC2253827

10.1371/journal.pone.0001721

18320042