DOTS-plus is effective only if implementation is optimal

If implementation of DOTS-plusa strategy using second line drugs to treat patients with drug resistant tuberculosiswere optimal, fewer deaths from tuberculosis would occur than with optimal DOTS (the directly observed treatment, short course; WHO's recommended tuberculosis treatment plan). In a decision analysis, Sterling and colleagues (p 574) found that if DOTS-plus decreased the effectiveness of DOTS even slightly (by 5%), more deaths from tuberculosis would occur than under DOTS. The authors state that if DOTS-plus is implemented in the developing world it must not divert resources from and decrease the effectiveness of DOTS.

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Relevant Article

Impact of DOTS compared with DOTS-plus on multidrug resistant tuberculosis and tuberculosis deaths: decision analysis

Timothy R Sterling, Harold P Lehmann, and Thomas R Frieden
BMJ 2003 326: 574. [Abstract] [Full Text] [PDF]