Community-based directly observed treatment, short-course (CB-DOTS) for tuberculosis (TB) involves training community health workers to increase awareness, detection, and treatment of TB and brings services directly to the homes of those at risk for infection. This strategy is used by ministries of health and national TB programs to expand high-quality DOTS and universal access to TB services. The World Health Organization’s DOTS strategy, which is used by MSH, combines the following five components:

  • Political commitment with increased and sustained financing,
  • Case detection through quality-assured bacteriology,
  • Standardize treatment, with supervision and patient support,
  • An effective drug supply and management system, and
  • Monitoring and evaluation systems as well as impact measurement. 

 CB-DOTS engages community-level volunteers in these elements of TB service provision and is known to be one of the most cost-effective approaches to TB control. 

MSH supports CB-DOTS implementation in eight nations through the USAID-funded TB CARE I and Task Order 2015 projects. In collaboration with international partners, ministers of health, district-level leaders, nongovernmental organizations, and community-based staff, we work to implement CB-DOTS by:

  • Designing and managing national strategic plans for CB-DOTS application, expansion, and sustainability; 
  • Developing and disseminating standard operation procedures for CB-DOTS case detection and treatment;
  • Recruiting and training community health workers to identify suspected cases of TB, provide DOTS, and refer patients in need of additional treatment to health facilities;
  • Organizing and co-facilitating community-based TB awareness and stigma-reduction sessions; and
  • Strengthening national-, district-, and community-level CB-DOTS recording and reporting systems.

Through the USAID-funded Tuberculosis Control Assistance Program (TB CAP) and the TB CARE I project in Afghanistan, MSH has been implementing CB-DOTS in Kabul and 13 of the nation’s provinces since 2009. Working with local partners, we have trained 9,000 community health workers on TB case identification, DOTS provision, and patient referrals. Our training has also equipped these volunteer health workers to organize and facilitate TB awareness-raising activities to improve prevention outreach and timely diagnosis. In less than four years of project implementation, CB-DOTS has improved Afghani’s access to TB services and increased the nation’s DOTS coverage.