Supporting treatment adherence and directly observed therapy

What it is

Individual case management with directly observed therapy (DOT) is preferred for all patients to ensure adherence and prevent emergence of drug resistance. DOT is treatment supervised by a healthcare professional or family member, where the person is observed swallowing their medication to improve adherence; dosing frequency may be reduced to three times a week to make DOT more convenient. Poor adherence is a major factor in prolonged illness, risk of relapse, and the emergence of drug resistance.

The criteria for implementing it are patients thought unlikely to comply, whether from a history of serious mental illness or a history of non-adherence to TB therapy in the past or during the current treatment course; homeless people; and multi-drug resistant TB.

It is not a step beside the antituberculous regimen but part of it: how often the drugs may be given depends on whether the doses are being observed.