The New Straits Times, March 25, 2001
By Professor Dzulkifli Abdul Razak
YESTERDAY was 2001 World TB Day. The theme this year is "DOTS: TB cure for all". It stresses the urgent need of access to TB treatment and cure as part of the "right to the highest attainable standard of health".
It also calls for equitable access to TB services for anyone who has TB, "free from discrimination _ rich or poor, man or woman, adult or child, imprisoned or free". There are two main objectives of World TB Day. The first is to mobilise political leaders and decision-makers around the world about the situation of TB sufferers, and the fact that there is no excuse for inaction in the face of an available, cost-effective cure.
Secondly, the idea is to make more aware a cure for TB is available and that accessing and completing TB treatment, without stigma or discrimination, is an important step in realising one's right to health.
What is DOTS? It stands for Directly Observed Treatment, Short-course. It is deemed by the World Health Organisation (WHO) to be "the most effective strategy available for controlling the TB epidemic today" _ proven as a successful, innovative approach to TB control in many countries. The five elements of the DOTS strategy are: - Government commitment to sustained TB control activities.
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Case detection by sputum smear microscopy among symptomatic patients self-reporting to health services.
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Standardised treatment regimen of six to eight months for at least a sputum smear positive cases, with directly observed therapy (DOT) for at least the initial two months.
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A regular, uninterrupted supply of all essential anti-TB drugs.
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A standardised recording and reporting system that allows assessment of treatment results for patient and of the TB control programme performance overall.
DOTS therefore is one strategy to prevent the emergence of drug-resistant TB by ensuring that patients adhere to the full course of treatment. In this context it refers to all DOTS-based strategies, including DOTS-Plus for multi-drug-resistant TB (MDR-TB) and TB/HIV. MDR-TB is a specific form a drug-resistant TB due to a bacillus resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs as highlighted in the previous column.
DOTS-Plus is a comprehensive management strategy under development and testing encompassing the above five tenets as a supplement to the standard DOTS strategy. It is needed in areas where MDR-TB has emerged due to previous inadequate TB control programmes.
However it is only recommended in settings where DOTS strategy is fully in place to protect against the creation of further drug resistance.
In areas of minimal or no drug resistance, DOTS, achieves cure rates of up to 95 per cent; rate high enough to dramatically reduce the TB burden while preventing the emergence of drug resistant TB.
Yet according to WHO, in 1999 only about 24 per cent of all TB patients were treated through the DOTS strategy. In view of the fact that DOTS is still not widely used, the role of DOTS workers and the community is crucial in ensuring that the right to health for each patient becomes a reality, even in remote communities and minority populations.
WHO and its international partners have formed the DOTS-Plus Working Group, in the attempt to determine the best strategy to manage MDR-TB. In other words, strengthening TB control globally will help to reduce TB mortality, morbidity and transmission.
Presently, TB is the second biggest contributor among infectious diseases to adult mortality being responsible for approximately two million deaths a year worldwide. WHO estimates that one-third of the world's population is infected with Mycobacterium tuberculosis _ the TB germs.
In the next 10 years, thirty million people could die from the disease. Between year 2000 and 2020, nearly one billion people will be newly infected, 200 million people will get sick, and 35 million will die from TB.
Indeed, if control is not further strengthened, everyone is vulnerable to the consequences of poor TB treatment practices. This year's World TB Day is therefore a call to civil society to provide an environment that encourages everyone with TB to seek treatment and cure. This is an important message that must be acted upon urgently, especially when the number of TB cases is rapidly raising as a result of the HIV/AIDS epidemic.
In fact, the 2001 World TB Day message is good for diseases. Given the way the health sector is developing there is an urgent need for equitable access to treatment and cure as part of the "right to the highest attainable standard of health", especially now that Malaysia is contemplating a National Health Finance Scheme. The clarion call too must be one that is "free from discrimination _ rich or poor, man or woman, adult or child, imprisoned or free".
Source, http://www.who.int/gtb/dots/index.html
