Directly Observed Therapy (DOT) for the Treatment of Tuberculosis
Fact sheet describing how to use DOT with TB patients.
On this page:
What is DOT?
Why use DOT?
Who can deliver DOT?
How is DOT administered?
How can a DOT provider build rapport and trust?
Download PDF version formatted for print:
Directly Observed Therapy (DOT)
for the Treatment of Tuberculosis (PDF: 63KB/1 page)
National TB treatment guidelines strongly recommend using a patient-centered case management approach - including directly observed therapy (“DOT”) - when treating persons with active TB disease. DOT is especially critical for patients with drug-resistant TB, HIV-infected patients, and those on intermittent treatment regimens (i.e., 2 or 3 times weekly).
What is DOT?
DOT means that a trained health care worker or other designated individual (excluding a family member) provides the prescribed TB drugs and watches the patient swallow every dose.
Why use DOT?
- We cannot predict who will take medications as directed, and who will not. People from all social classes, educational backgrounds, ages, genders, and ethnicities can have problems taking medications correctly.
- Studies show that 86-90% of patients receiving DOT complete therapy, compared to 61% for those on self-administered therapy.
- DOT helps patients finish TB therapy as quickly as possible, without unnecessary gaps.
- DOT helps prevent TB from spreading to others.
- DOT decreases the risk of drug-resistance resulting from erratic or incomplete treatment.
- DOT decreases the chances of treatment failure and relapse.
Who can deliver DOT?
- A nurse or supervised outreach worker from the patient’s county public health department normally provides DOT.
- In some situations, it works best for clinics, home care agencies, correctional facilities, treatment centers, schools, employers, and other facilities to provide DOT, under the guidance of the local health department.
- Family members should not be used for DOT. DOT providers must remain objective.
- For complex regimens including IV/IM medications or twice daily dosing, home care agencies may provide DOT or share responsibilities with the local health department.
- If resources for providing DOT are limited, priority should be given to patients most at risk. See the MDH DOT Risk Assessment form for help identifying high-priority patients.
How is DOT administered?
- DOT includes:
- delivering the prescribed medication
- checking for side effects
- watching the patient swallow the medication
- documenting the visit
- answering questions
- DOT should be initiated when TB treatment starts. Do not allow the patient to try self-administering medications and missing doses before providing DOT. If the patient views DOT as a punitive measure, there is less chance of successfully completing therapy.
- The prescribing physician should show support for DOT by explaining to the patient that DOT is widely used and very effective. The DOT provider should reinforce this message.
- DOT works best when used with a patient-centered case management
approach, including such things as:
- helping patients keep medical appointments
- providing ongoing patient education
- offering incentives and/or enablers
- connecting patients with social services or transportation
- Patients taking daily therapy can usually self-administer their weekend doses.
How can a DOT provider build rapport and trust?
| 1. | “Start where the patient is.” |
| 2. | Protect confidentiality. |
| 3. | Communicate clearly. |
| 4. | Avoid criticizing the patient’s behavior; respectfully offer helpful suggestions for change. |
| 5. | Be on time and be consistent. |
| 6. | Adopt and reflect a nonjudgmental attitude. |
For further information or assistance making referrals for DOT, contact the Minnesota Department of Health, TB Prevention and Control Program, (651) 201-5414.
Adapted from materials from the Francis J. Curry National Tuberculosis Center and the New York City Department of Health.
References:
1.Treatment of Tuberculosis, American Thoracic Society, CDC and Infectious
Diseases Society of America, Am J Respir Crit Care Med, Vol 167, 2003
(on line at: www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm)
2. Interactive Core Curriculum on Tuberculosis (Web-based), CDC, 2004
www.cdc.gov/tb/webcourses/corecurr/index.htm
3. “DOT Essentials: A Training Curriculum for TB Control Programs”,
Francis J. Curry National Tuberculosis Center, 2003
4. “Management: Directly Observed Therapy”, New York City
Department of Health, 2001.
