DOTS, the missing componenet.....

Tubercolosis is a disease with a a heavy global burden. it is an illness of the poor, marginalised and the vulnerable. Every year, 8 million new cases of Tuberculosis are reported. 95% of them occur in developping countries. 2 million people die every year due to Tuberculosis.

Directly Observed Treatment Shortcurse (DOTS), is the only proven effective means by which 85% cure rate can be achieved on a programme basis. DOTS is a systemic strategy with five components:

1. Political Commitment: Tuberculosis cna be cured! Thus governments are demanded for assigning necessary priority and allocating essential resources for Tuberculosis control.
2. Good Quality Diagnosis: Highly sensitive, specific yet affordabletest for Tuberculosis diagnosis is sputum smear microscopy.
3. Good Quality Drugs: The weapon that changed the course of deadly tuberculosis disease was good quality drugs. All people should have access to quality, effective and safe anti-tuberculosis drugs at affordable prices to cure themselves.
4. Short-course Chemotherapy given under direct observation: A non health wroker or trained person who is not a family member observes the patient swallowing the drugs. It shifts the responsability for cure from patient to the health care system.
5. Systematic monitoring and accountability: Every Tuberculosis patient needs to be recorded and followed up. This is the key to enhancing public acceptance of the programme and the prevention of emergence of Multi-Drug Resistance (MDR) Tuberculosis.

However, I am of the opinion that DOTS is missing a very important sixth component, that is the need to address Stigma aggressivelt. Tuberculosis patients have to interact with many groups of people, when a patient is diagnosed as TB, he or she is often stigmatised. The fact is that a ptient who is taking anti-TB drugs becomes non-infectious within 2 weeks with modern drugs. We interact with many undiagnosed Tuberculosis patients daily, who are infecting others but not taking drugs. Tuberculosis is accepted as a disease with unbelievable loads of stigma. Infact, patients have to fight two lethal organisms simultaniously, namely Mycobacterium tubercolosis and Social stigam lethalis! Expensive behavioural change communication programmes have been conducted to reduce the social stigma of Tuberculosis, however, we recently discovered a massive load of stigma towards Tuberculosis amongst a fairly educated crowd of officials. Is it that the media driven promotional campaign is not reaching the grass root level or should we refine the message in a more socially acceptable manner? It is high time that we hunt for this very important yet missing component of DOTS strategy.