Treatment adherence and directly observed therapy (DOT)

Patient-centred case management helps patients to adhere to drug therapy, which is key to the successful treatment of TB. Strict adherence is essential to:

• achieve a satisfactory treatment outcome
• reduce the risk of transmission
• reduce the risk of relapse
• prevent the emergence of drug resistance.

Prolonged treatment durations, complex drug regimens, and adverse effects associated with TB therapy often have a significant impact on patient adherence. Adherence is improved by comprehensive patient and family education using verbal and written information, close follow-up, and provision of directly observed therapy (DOT) if appropriate.

In directly observed therapy, trained healthcare professionals supervise administration of TB medication. Directly observed therapy is indicated for patients likely to be nonadherent; it may be required in the early stages of treatment or throughout treatment. Assess the need for directly observed therapy on a case-by-case basis. Directly observed therapy should be used for children with TB when the ability of caregivers to administer medication is assessed to be unreliable. Directly observed therapy is also recommended for patients with drug-resistant TB, and when intermittent (three-times-weekly) therapy is used.

Some patients require directly observed therapy in the initial stage of treatment only—in the absence of adverse drug effects, the need for directly observed therapy can diminish as patients become familiar with their drug regimen. Continue directly observed therapy for as long as there is concern about adherence.

Regardless of whether directly observed therapy is used, it is important that the treating team maintains close contact with the patient to monitor adherence and identify adverse effects early.