148:, "You know the worldwide epidemic of TB is entering a critical stage when the cash-strapped World Health Organization spends a fortune on glossy paper, morbid photos and an interactive, spinning (!) cover for its 1995 TB report." India's Joint Effort to Eradicate TB NGO observed that, "DOTS became a clarion call for TB control programmes around the world. Because of its novelty, this health intervention quickly captured the attention of even those outside of the international health community."
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133:, developed an even more concise "Framework for TB Control" focusing on five main elements and nine key operations. The initial emphasis was on "DOT, or directly observed therapy, using a specific combination of TB medicines known as short-course chemotherapy as one of the five essential elements for controlling TB. In 1993, the World Bank's
170:, "We anticipate that at least 10 million deaths from TB will be prevented in the next ten years with the introduction and extensive use of the DOTS strategy." Upon Nakajima's death in 2013, WHO recognized that the promotion of DOTS was one of WHO's most successful programs developed during his ten-year administration.
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began investigating the potential expansion of this strategy. In July 2008, the World Bank invited Styblo and WHO to design a TB control project for China. By the end of 2007 this pilot project was achieving phenomenal results, more than doubling cure rates among TB patients. China soon extended this
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In the Fall of 1994, Kraig Klaudt, WHO's TB Advocacy
Officer, developed the name and concept for a marketing strategy to brand this complex public health intervention. To help market "DOTS" to global and national decision makers, turning the word "dots" upside down to spell "stop" proved a memorable
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There has been a steady uptake of DOTS TB control services over the subsequent decades. Whereas previously less than 2% of infectious TB patients were being detected and cured, with DOTS treatment services in 1990 approximately 60% have been benefitted from this care. Since 1995, 41 million people
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in the 1970s and 80s, primarily in
Tanzania, but also in Malawi, Nicaragua and Mozambique. Styblo refined "a treatment system of checks and balances that provided high cure rates at a cost affordable for most developing countries." This increased the proportion of people cured of TB from 40% to
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A systematic review of randomized clinical trials found no difference for cure rates as well as the treatment completion rates between directly observed therapy (DOT) and self-administered drug therapy. A 2013 meta-analysis of both clinical trials and observational studies too did not find any
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As of 1997, in its revised guidelines for national TB control programs, WHO increasingly stopped spelling out the DOTS acronym. This was due to the perceived overemphasis on the directly observed therapy component (DOT), which is only one of the five essential components of DOTS. See
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During the early 1990s, WHO determined that of the nearly 700 different tasks involved in Styblo's meticulous system, only 100 of them were essential to run an effective TB control program. From this, WHO's relatively small TB unit at that time, led by
155:, head of the city's Bureau of TB Control captured the essence of DOTS, "TB control is basically a management problem." Frieden had been credited for using the strategy to turn around New York City's TB outbreak a few years earlier.
45:. According to WHO, "The most cost-effective way to stop the spread of TB in communities with a high incidence is by curing it. The best curative method for TB is known as DOTS." DOTS has five main components:
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difference between DOTS and self-administered therapy. However, the WHO and all other TB programs continue to use DOTS as an important strategy for TB delivery for fear of drug resistance.
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have been successfully treated and up to 6 million lives saved through DOTS and the Stop TB Strategy. 5.8 million TB cases were notified through DOTS programs in 2009.
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Government commitment (including political will at all levels, and establishment of a centralized and prioritized system of TB monitoring, recording and training)
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Standardized treatment regimen directly of six to nine months observed by a healthcare worker or community health worker for at least the first two months
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The DOTS report was released to the public on March 20, 1995, at New York City's Health
Department. At the news conference,
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Ogden, J.; et al. (2003). "The politics of 'branding' in policy transfer: the case of DOTS for tuberculosis control".
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Klaudt, K. (2000). "The
Political Causes and Solutions of the Current Tuberculosis Epidemic." In J. Whitman (Ed.),
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claimed that the TB control strategies used in DOTS were one of the most cost-effective public health investments.
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edited by Ruth Levine, 31–37. Washington, D.C.: Center for Global
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A guide to
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nearly 80%, costing up to $ 10 per life saved and $ 3 per new infection avoided.
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Volmink J, Garner P. Directly observed therapy for treating tuberculosis.
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2007, Issue 4. Art. No.: CD003343. DOI:10.1002/14651858.CD003343.pub3.
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and do not remove this message until the contradictions are resolved.
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220:"Tuberculosis." WHO factsheet (revised). No. 104. March 1996.
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The
Politics of Emerging and Resurgent Infectious Diseases
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19:"DOTS" redirects here. For the brand of gumdrops, see
439:"Directly observed therapy for treating tuberculosis"
330:"Lives in Turnaround: WHO knows how to address TB."
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Treatment of TB: Guidelines for
National Programmes.
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244:Millions Saved: Proven Successes in Global Health,
114:International Union Against TB & Lung Disease
108:The technical strategy for DOTS was developed by
380:"Is DOTS the Health Breakthrough of the 1990s?"
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242:"Controlling Tuberculosis in China." In
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362:(pp. 86–109). London: MacMillan Press.
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344:"WHO Calls for Action Against TB".
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268:Oxford University Press: New York.
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401:. 28 January 2013. Archived from
188:multi-drug-resistant tuberculosis
486:Pasipondya, JG; Gumbo T (2013).
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16:Tubercuolosis treatment strategy
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437:Volmink, J; Garner P (2015).
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229:"TB: Join the DOTS."
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120:In 2007, WHO and the
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233:May 20, 1995. P. 89.
281:"Creation of DOTS"
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