Urban DOTS

The world’s population of urban residents has grown steadily over the past decade. It is estimated that urban residents currently represent more than 60 percent of world’s population, as compared to 30 percent in 1950. Uncontrolled urban growth can often lead to threatening health conditions due to inadequate security, sanitation, and health systems. Over the last two decades the world’s largest cities have seen a surge in TB incidence, particularly in urban slums. While dense populations and overcrowding exacerbate TB transmission, today’s urban populations are also challenged by inadequate HIV & AIDS control measures and a rise in the population of high-risk groups. 

In response to these conditions, MSH is working to expand TB service provision in densely populated areas of Afghanistan, Uganda, Ethiopia, and Ghana. A key component of this work involves implementing the World Health Organization’s directly observed treatment, short-course (DOTS) strategy, which 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. 

When implemented in urban settings, DOTS improves TB service delivery by involving public and private health care providers in TB control efforts. Specifically, our teams work alongside national TB programs and local stakeholders to train city-based health facility staff to identify individuals with TB symptoms, provide timely TB testing and treatment, supervise patients’ medication intake, and accurately register and report TB-related data. We also train these health workers to improve TB case detection by encouraging and facilitating TB testing for people living with or in close contact with TB patients.

Through three PEPFAR- and USAID-funded projects (TB CARE I, Help Ethiopia Address Low TB (HEAL TB), and TRACK TB), MSH collaborates with national control programs, public and private sector partners, and other stakeholders to develop and implement urban DOTS strategic plans and standard operating procedures for TB prevention, case detection, and treatment. 

From 2008 to 2012, MSH’s work through the USAID-funded Tuberculosis Control Assistance Program (TB CAP) and the TB CARE I Afghanistan project helped to increase health facility DOTS coverage by 210 percent in Kabul. Within this four-year period, our urban DOTS interventions also contributed to the following outcomes in Kabul city:

  • Identification of individuals with TB symptoms increased tenfold,
  • TB case detection increased by 60 percent,
  • Patients who transferred out of TB treatment dropped by 33 percent, and
  • The TB treatment success rate increased by 49 percent.