13.3 Global strategy for the prevention and control of TB
In 1994, WHO launched their global strategy for the prevention and control of TB. The key feature of the strategy remains the Directly Observed Treatment, Short-course (DOTS), as the best approach to TB. DOTS has five key components:
- Sustained government political and financial commitment to TB control
- Access to quality-assured laboratories for the confirmation of persons suspected of having TB
- Uninterrupted supply of quality-assured drugs to treat TB
- Standardised treatment and care for all TB cases, including Directly Observed Treatment Short-course (DOTS)
- Setting up of a recording and reporting system through which the progress of patients and the overall performance of the TB control programme can be assessed. Box 13.1 outlines the records and forms that will be used to monitor the progress of your patients and how effectively TB is being controlled in your area.
Box 13.1 Record keeping and the TB patient
To help TB patients, you will need to know about different forms that need to be completed. For example, a TB lab register is used to record information on all patients investigated for TB; a sputum request form needs to be sent with the sputum samples that are sent for investigation. A TB unit register has to be completed for all patients where TB is detected, where the details of their treatment are recorded; there is also a TB referral/transfer form. Find out from where you work what these different forms looks like. Keeping them up-to-date is essential for checking the progress of patients and seeing how effective the control of TB in your area is proving.
Let us focus now on those components of the DOTS strategy that are carried out at the health facility and community levels. As you’ve just read, one of the most important components of the global strategy is the Directly Observed Treatment, Short-course, which means that a health worker or a treatment supporter (such an individual could be a family member, a religious or community leader) must support and watch the patient taking each dose of his/her treatment. DOTS is important to:
- Ensure that patients take the correct treatment regularly
- Detect when a patient misses a dose, find out why, and solve the problem
- Monitor and solve any problem that the patient may experience during treatment.