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9.0 Directly observed therapy (DOT)

The use of directly observed therapy is held up as the gold standard by WHO and CDC for the treatment of HIV related tuberculosis especially when using intermittent dosing.  It is recommended that all patients with MDR-TB have DOT. [AII]

It should be noted that the superiority of DOT over self-administered therapy for the treatment of TB in developing countries is yet to be proven. Controlled, randomized trials performed in South Africa and Pakistan showed similar treatment completion and cure rates for DOT and self-administered TB treatment.  76-78 

In contrast, investigators in Thailand found higher treatment completion and cure rates in patients assigned to DOT compared to self-administered treatment, however special conditions pertained to the patients in this study.  79

Patient centered care should be at the core of multidisciplinary management and should always include an adherence strategy that emphasizes DOT. This may include DOT/supervised therapy for antivirals. 80  [BIII]

However there are no published data on the utility and efficacy of combined HAART/TB DOT in treating co-infection.

DOT usually requires that patients be observed to ingest each dose of antituberculosis medication, to try and ensure the completion of therapy. Any treatment plan should be individualized to incorporate measures that facilitate adherence to the drug regimen. Such measures may include, for example, social service support, treatment incentives, housing assistance, referral for treatment of substance misuse, and co-ordination of tuberculosis services with those of other providers.