Directly Observed Therapy: A Case Study

A mandatory nationwide surveillance of patients with TB positivity that requires medication. The local health department must ensure medications are being provided to all TB positive patients undergoing treatment regardless of their payment status. Thus, programs such as DOT (Directly Observed Therapy) must be mandated -Through this program, each TB patient is assigned a DOT worker. The DOT worker meets with the patient to ensure that the patient is taking their medication to facilitate the process. DOT has become the standard of care for all TB patients in NY State.
43 million people were saved through TB diagnosis and treatment from 2000- 2014. Thus, treatment can cure patients from active TB or spreading it to others.

One of the main reasons for TB relapse, treatment failure,
or becoming drug resistant is due to lack of compliance of TB medications by patients. To tackle this problem, Directly Observed Therapy (DOT) has been introduced through Medicaid and other reimbursement, which is totally free of cost to the patients. The state requires that DOT must be provided to all active TB patients and the local health department is responsible for arranging DOT case management services. This helps the healthcare practices and physicians ensure that the patients are taking their medications regularly. This program, if introduced as a law nationwide, can help to eradicate TB from the entire country by providing and completing the full course of the appropriate treatment.
Multi-drug resistant tuberculosis (MDR TB) patients who has ceased to comply with completion of the medical treatment against medical advice should be issued an isolation order by the local health officer. This includes those who are not actively infectious but refuses treatment.

Approximately, 43 million people were saved through TB diagnosis and treatment from 2000- 2014.
However, in 2014, approximately 480,000 people developed multidrug resistant TB (MDR-TB) in the world. Thus, treating with the right TB medications is vital for patients with active or latent TB infection. Patients who refuse TB treatment against medical advice are endangering the exposure of the infection to the public thus needs to be detained or isolated.
The policy is hoping to emphasize the importance of complying with medical treatment if advised. It ensures that patients follows the medical management regardless of their infection status in order to provide a safer environment for the public and people in close contact to the patient.
State or local health department mandated infectious diseases, including TB, awareness courses with certifications in schools and healthcare facilities every year. TB courses must be made mandatory in TB- prone areas such as states with high immigrant populations.
Lack of health knowledge can lead to the risk of being exposed to risk factors such as HIV, substance abuse, smoking, and immigrants or travelers infected with TB, and delay in seeking
treatment.
For example, in 2014, 1,269 TB cases were reported in Texas. 55% of those reported cases were among Hispanics. The rates were higher along the Texas-Mexico border. In such states with high foreign born or immigrants from TB prone areas, TB awareness courses must be implemented.
This policy is hoping to raise awareness of the public by educating them of the disease, its symptoms, complications, and dangers if not identified and treated promptly. It also helps to promote TB screening tests for high risk population and people living in TB- prevalent areas.