The DOTS Way of

Controlling TB
Paper Presentation by Irfan Ismail Ayub.
Guide – Dr. Ravi Shankar, MD.,
Professor, Dept of Comm Med.
Introduction
DOTS in 180 countries.
Adopted as the RNTCP in India.
Adapted and implemented in India in 1993.
Fully fledged DOTS programme in 1997.
By 2005 end – 97 % coverage, thus in
routine implementation phase – Category 4.
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What is DOTS ?
Directly Observed treatment Short Course
The control of TB in India was not
successful till the establishment of the
RNTCP taking DOTS as its instrument.
RNTCP – 1 st phase – 1997 to 2005, was
the expansive phase in India.
Now in second phase – 2006 – 2010, to
consolidate, widen services and sustain
achievements.
Aim of RNTCP

Detect 70 % of new smear

positive TB.
Cure 85 % of them.
Implementation of DOTS.
 DTC

OTHERS
CGHS
ESI
Community Railways
TBC
Govt Hosp Health PHC Sanotoria
Religious
Centres Missions,
Private
Charity
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Every day in India, under the RNTCP, more
than 15,000 patients are being examined for
TB, free of charge.
Diagnosis and follow-up of patients on
treatment is achieved through examination
of more than 50,000 laboratory specimens.
Every day, about 3,500 patients are started
on treatment, and nearly 2,500 of them are
cured after treatment,
More than 600,000 health care workers
have been trained and more than 11,500
designated laboratory Microscopy Centres
have been upgraded and supplied with
binocular microscopes since the inception of
the RNTCP
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DOTS Chemotherapy
Category Type of patient Regimen

I -New sputum + 2 (HRZE)3

-Seriouly ill – 4 (HR) 3
sputum (–) or extra
pulm
II Sputum + : 2 (HRZES) 3
Relapse, Failure , 1 (HRZE) 3
after default 5 (HRE) 3
III Sputum (-), extra 2 (HRZ) 3
pulm, not seriouly 4 (HR) 3
ill.
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Stop TB Strategy
1. Pursue quality DOTS expansion
and enhancement, by improving the case
finding and cure through an effective
patient-centred approach to reach all
patients, especially the poor.
2. Address TB-HIV, MDR-TB and
other challenges, by scaling up TB-HIV
joint activities, DOTS Plus, and other
relevant approaches.
3. Contribute to health system
strengthening, by collaborating with
other health programmes and general
services
4. Involve all health care providers, public,
nongovernmental and private, by scaling up
approaches based on a public-private mix (PPM),
to ensure adherence to the International
Standards of TB care.
5. Engage people with TB, and affected
communities to demand, and contribute to
effective care. This will involve scaling-up of
community TB care; creating demand thorugh
context-specific advocacy, communication and
social mobilization.
6. Enable and promote research for the
development of new drugs, diagnostic and
vaccines. Research will also be needed to
improve programme performance.
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In 2005, more than 1290,000
cases were placed on treatment -
largest cohort of cases, more
than any other country in the
world.
By March 2006, more than 5.4
million patients have been initiated
on treatment, saving almost a
million additional lives.
The success of DOTS in India has
determine the success of TB
control in the world.
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