Facility-based directly observed therapy (DOT) for tuberculosis during COVID-19: A community perspective. (August 2021)

• Record Type: Journal Article
• Authors: Zimmer, Alexandra J.; Heitkamp, Petra; Malar, James; Dantas, Cintia; O'Brien, Kate; Pandita, Aakriti; Waite, Robyn C.
• Is Part Of: Journal of clinical tuberculosis and other mycobacterial diseases. Volume 24(2021)
• Publication Date: 2021-08
• Subjects: Tuberculosis -- COVID-19 -- Directly observed therapy -- Human rights; Tuberculosis -- Periodicals; Mycobacterial diseases -- Periodicals; 616.995
• DOI: 10.1016/j.jctube.2021.100248
• Languages: English
• ISSNs: 2405-5794

Abstract

Highlights: The COVID-19 pandemic has amplified the human rights issues of facility DOT. Transportation, stigma, fear of COVID, and restriction of liberties are barriers to facility DOT. Where possible, facility DOT should be replaced by vDOT and multi-month dispensing. Community-based DOT should be prioritized over facility-based DOT. People with TB must be empowered to participate in the TB response to enable a person-centred model of care. Abstract: Facility-based directly observed therapy (DOT) has been the standard for treating people with TB since the early 1990s. As the commitment to promote a people-centred model of care for TB grows, the use of facility-based DOT has been questioned as issues of freedom, privacy, and human rights have been raised. The disruptions caused by the COVID-19 pandemic and ensuing lockdown measures have fast-tracked the need to find alternative methods to provide treatment to people with TB. In this study, we present quantitative and qualitative findings from a global community-based survey on the challenges of administering facility-based DOT during a pandemic as well as potential alternatives. Our results found that decreased access to transportation, the fear of COVID-19, stigmatization due to overlapping symptoms, and punitive measures against quarantine violations have made it difficult for persons with TB to receive treatment at facilities, particularly in low-resource settings. Potential replacements included greater focus on community-based DOT, home delivery of treatment, multi-month dispensing, and video DOT strategies. Our study highlights the need for TB programs to re-evaluate their approach to providing treatment to people with TB, and that these changes must be made in consultation with people affected by TB and TB survivors to provide a true people-centred model of care.