Directly observed treatment (DOT) is one of the components of the World Health Organisation’s (WHO) tuberculosis (TB) control strategy.
The Department recommends that TB services follow the guidelines developed by the national institute for health and clinical excellence (NICE). NICE define DOT as ‘direct observation by a health professional or other person such as a family member, where swallowing of the medication is observed’. DOT may also include increased contact between the care provider and patient, support and provision of incentives (e.g. food vouchers).
NICE guidelines indicate that the use of DOT is not usually necessary in the management of most cases of TB, but all patients should have a risk assessment for adherence to treatment.
DOT is recommended for patients who have adverse factors on their risk assessment, in particular:
street—or shelter—dwelling homeless patients with active TB
TB patients with serious mental illness
TB patients with drug-resistances
TB patients with likely poor adherence, in particular those who have a history of non-adherence
In 2007, the Department initiated a ‘Find and Treat’ (F and T) project to actively look for cases of TB among the homeless and other vulnerable groups in London, and to promote the use of DOT, which provides supervised medication and support to patients to improve adherence to treatment. Currently, the F and T team is helping over 300 people with TB who have challenging lifestyles to complete their treatment.
DOT is not mandatory. The Public Health (Control of Disease) Act 1984 stipulates that a justice of the peace may, under certain circumstances, order that an individual undergo medical examination or be removed to or detained in a hospital. No-one can be forced to undertake medical treatment.