Has the DOTS strategy improved case finding or treatment success? An empirical assessment.

<h4>Background</h4>Nearly fifteen years after the start of WHO's DOTS strategy, tuberculosis remains a major global health problem. Given the lack of empirical evidence that DOTS reduces tuberculosis burden, considerable debate has arisen about its place in the future of global tube...

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Autores principales:	Ziad Obermeyer, Jesse Abbott-Klafter, Christopher J L Murray
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2008
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/ca4f0538c030427b8893af70dd8c450d
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spelling	oai:doaj.org-article:ca4f0538c030427b8893af70dd8c450d2021-11-25T06:13:11ZHas the DOTS strategy improved case finding or treatment success? An empirical assessment.1932-620310.1371/journal.pone.0001721https://doaj.org/article/ca4f0538c030427b8893af70dd8c450d2008-03-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/18320042/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Nearly fifteen years after the start of WHO's DOTS strategy, tuberculosis remains a major global health problem. Given the lack of empirical evidence that DOTS reduces tuberculosis burden, considerable debate has arisen about its place in the future of global tuberculosis control efforts. An independent evaluation of DOTS, one of the most widely-implemented and longest-running interventions in global health, is a prerequisite for meaningful improvements to tuberculosis control efforts, including WHO's new Stop TB Strategy. We investigate the impact of the expansion of the DOTS strategy on tuberculosis case finding and treatment success, using only empirical data.<h4>Methods and findings</h4>We study the effect of DOTS using time-series cross-sectional methods. We first estimate the impact of DOTS expansion on case detection, using reported case notification data and controlling for other determinants of change in notifications, including HIV prevalence, GDP, and country-specific effects. We then estimate the effect of DOTS expansion on treatment success. DOTS programme variables had no statistically significant impact on case detection in a wide range of models and specifications. DOTS population coverage had a significant effect on overall treatment success rates, such that countries with full DOTS coverage benefit from at least an 18% increase in treatment success (95% CI: 5-31%).<h4>Conclusions</h4>The DOTS technical package improved overall treatment success. By contrast, DOTS expansion had no effect on case detection. This finding is less optimistic than previous analyses. Better epidemiological and programme data would facilitate future monitoring and evaluation efforts.Ziad ObermeyerJesse Abbott-KlafterChristopher J L MurrayPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 3, Iss 3, p e1721 (2008)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Ziad Obermeyer Jesse Abbott-Klafter Christopher J L Murray Has the DOTS strategy improved case finding or treatment success? An empirical assessment.
description	<h4>Background</h4>Nearly fifteen years after the start of WHO's DOTS strategy, tuberculosis remains a major global health problem. Given the lack of empirical evidence that DOTS reduces tuberculosis burden, considerable debate has arisen about its place in the future of global tuberculosis control efforts. An independent evaluation of DOTS, one of the most widely-implemented and longest-running interventions in global health, is a prerequisite for meaningful improvements to tuberculosis control efforts, including WHO's new Stop TB Strategy. We investigate the impact of the expansion of the DOTS strategy on tuberculosis case finding and treatment success, using only empirical data.<h4>Methods and findings</h4>We study the effect of DOTS using time-series cross-sectional methods. We first estimate the impact of DOTS expansion on case detection, using reported case notification data and controlling for other determinants of change in notifications, including HIV prevalence, GDP, and country-specific effects. We then estimate the effect of DOTS expansion on treatment success. DOTS programme variables had no statistically significant impact on case detection in a wide range of models and specifications. DOTS population coverage had a significant effect on overall treatment success rates, such that countries with full DOTS coverage benefit from at least an 18% increase in treatment success (95% CI: 5-31%).<h4>Conclusions</h4>The DOTS technical package improved overall treatment success. By contrast, DOTS expansion had no effect on case detection. This finding is less optimistic than previous analyses. Better epidemiological and programme data would facilitate future monitoring and evaluation efforts.
format	article
author	Ziad Obermeyer Jesse Abbott-Klafter Christopher J L Murray
author_facet	Ziad Obermeyer Jesse Abbott-Klafter Christopher J L Murray
author_sort	Ziad Obermeyer
title	Has the DOTS strategy improved case finding or treatment success? An empirical assessment.
title_short	Has the DOTS strategy improved case finding or treatment success? An empirical assessment.
title_full	Has the DOTS strategy improved case finding or treatment success? An empirical assessment.
title_fullStr	Has the DOTS strategy improved case finding or treatment success? An empirical assessment.
title_full_unstemmed	Has the DOTS strategy improved case finding or treatment success? An empirical assessment.
title_sort	has the dots strategy improved case finding or treatment success? an empirical assessment.
publisher	Public Library of Science (PLoS)
publishDate	2008
url	https://doaj.org/article/ca4f0538c030427b8893af70dd8c450d
work_keys_str_mv	AT ziadobermeyer hasthedotsstrategyimprovedcasefindingortreatmentsuccessanempiricalassessment AT jesseabbottklafter hasthedotsstrategyimprovedcasefindingortreatmentsuccessanempiricalassessment AT christopherjlmurray hasthedotsstrategyimprovedcasefindingortreatmentsuccessanempiricalassessment
_version_	1718414070266200064

Has the DOTS strategy improved case finding or treatment success? An empirical assessment.

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