Connecting the DOTS: Should we still be doing directly observed therapy?

Abstract

Since the 1960s, the primary approach to treating tuberculosis (TB) worldwide has been directly observed therapy (DOT) (taking medication under supervision). Drawing on ethnographic data from Romania, literature on DOT globally and a human rights-based analysis, I argue that in many places DOT is not occurring as intended, and that it is ineffective, onerous to the people being treated and in conflict with their human rights. Instead, DOT should be one of several types of adherence supports from which people can choose within a rights-based and person-centered treatment that serves their varied needs through their long and difficult TB treatment.

ABSTRACT (ROMANIAN)

Începând din anii 1960, metoda principală de tratare a tuberculozei (TBC) la nivel global a fost tratamentul direct observat (DOT) (administrarea medicamentelor sub supraveghere). Argumentul meu, bazat pe rezultatele cercetării mele etnografice din România, studii asupra DOT la nivel global și o analiză fundamentată pe drepturile omului, este că, în multe locuri de pe mapamond, DOT nu este implementat conform intenției inițiale, este ineficace, împovărează persoanele cu TBC și le încalcă drepturile umane. DOT ar trebui de fapt să fie o opțiune printre mai multe servicii de suport al aderenței la tratament oferite persoanelor cu TBC în cadrul unui model de îngrijire centrat pe persoană și fundamentat pe drepturile omului care răspunde diverselor nevoi pe care acestea le-ar avea în timpul lungului și dificilului lor tratament pentru TBC.

Implications

Directly observed therapy (DOT) is a cornerstone of TB treatment globally. However, clinic-based DOT has no medical benefit and, when used without socio-economic and psychological supports, is widely recognized as causing harm to people with TB. National TB programs should instead offer human rights-based and person-centered TB treatment and support options that best fit people’s needs, which may or may not include DOT. Donor, civil society and technical organizations should support these efforts.

Video Abstract

Read the transcript

Watch the video on Vimeo

©2024 The Author(s). Published with license by Taylor&Francis Group, LLC

Social Media Statement

Using ethnographic data from Romania, Jonathan Stillo argues that mandatory Directly Observed Therapy (DOT) causes harm to people with TB and that DOT should only exist as an option within rights-based, person-centered treatment.

Keywords:

• Romania
• DOT
• human rights
• person-centered
• tuberculosis

Acknowledgements

The research was approved by the City University of New York Graduate Center IRB (08-05-1556, June 05, 2008). Local research permission was granted by the Romanian Ministry of Health and the Romanian National TB Control Program. Informed consent was obtained from all participants. All participant names are pseudonyms. Thanks to Ilinca Diaconu-Stillo for her editing assistance. I deeply thank the people with TB and the medical staff who made this work possible by sharing their lives with me. All opinions contained in this article are my own.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research has been supported by the US National Science Foundation (#0921137), Fulbright-Hays, the Social Science Research Council, IREX, the Romanian Cultural Institute and New Europe College–Bucharest.

Notes on contributors

Jonathan Stillo

Jonathan Stillo is a medical anthropologist and assistant professor at Wayne State University. His research and advocacy focus on the socio-economic and political dimensions of the global tuberculosis crisis. He is the Chair-Elect of STOP TB USA, the Co-Chair of TB Europe Coalition and a member of the Global TB Community Advisory Board.