A study by the UK Nuffield Institute of Health questions the effectiveness of direct observation for TB treatment in Pakistan. TB services in Pakistan have been neglected for years and treatment completion is low. People with TB are stigmatised and unmarried women have particular difficulty accessing health services. It is important to devise treatment strategies that impose little financial burden on patients, minimise stigma and improve access to care. This study examined the effectiveness of the final component of DOTS - direct observation.
Women are more likely than men to complete the course of treatment and to be cured.
Cure rates are higher among those directly observed by community health workers than those who visit health facilities. Many patients are unable to continue attending health facilities daily for observation. These results do not mean that direct observation of treatment is unnecessary in every setting. However, the inconvenience and costs of complying with directly observed treatment could outweigh the incentive to complete treatment. Stop TB also has many on-line resources.