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DIRECTLY OBSERVED THERAPY (DOT) & DIRECTLY OBSERVED PREVENTIVE THERAPY (DOPT) What it is & what it is not In a recent memorandum originating from the Bureau of Communicable Disease Control at the Texas Department of Health in Austin, the significance and value of DOT/DOPT was addressed from the point of view of what these very special adjuncts to tuberculosis chemotherapy are and what they are not. Clarification of these procedures is meant to insure uniformity of understanding and increase effectiveness through standardized use. While there are few published studies defining the value of DOT/DOPT, the experience of Dr. Stephen Weis in Fort Worth, Texas* has contributed significantly to developing the concept of DOT treatments as standard protocol, especially in areas of the United States where the risk of acquiring or developing tuberculosis, particularly drug resistant tuberculosis, is considered to be relatively high. Because Texas is one of these high risk areas, understanding DOT and DOPT is particularly important for all health care professionals working in this state. As part of its mission to support the Public Health Department and enhance the quality of health care in the state, The Center for Pulmonary and Infectious Disease Control (CPIDC), located at The University of Texas Health Center at Tyler (UTHCT) is providing copies of the original memorandum to health care professional and outreach workers. DOT/DOPT DEFINED: In DOT/DOPT, each patient with tuberculosis disease or infection receives medication at an appointed place and time and is observed ingesting EVERY DOSE. Successful DOT actually REDUCES the incidence of DRUG RESISTANCE and the RATE of RELAPSE of TB. Effective DOPT actually DECREASES the PROBABILITY that someone INFECTED with the TB organism will develop active TB disease. THE TUBERCULOSIS ELIMINATION DIVISION POLICY IS THAT ALL CASES AND SUSPECTS SHOULD BE ON DOT. ALL TB PATIENTS WHOSE ORGANISMS ARE RESISTANT TO ISONIAZID, RIFAMPIN OR BOTH ISONIAZID AND RIFAMPIN MUST BE ON DOT. *Weis, S.E., Slocum, P.C., Blais, F.X., et al. The Effect of Directly Observed Therapy on the Rates of Drug Resistance Relapse in Tuberculosis. N Eng J Med 1994; 330: 1179-84. DOT/DOPT IS... 1. ... a treatment technique where an outreach worker or health care provider OBSERVES the patient TAKING and SWALLOWING all anti-tuberculosis medications for each and every dose (of drugs) until completion of therapy. 2. ... When the patient is actually OBSERVED swallowing EVERY dose of DOT medications, especially when prescribed in divided doses. 3. ... provided ONLY by an outreach worker or health care provider who is TRAINED in observing, recognizing, documenting and reporting possible side effects of medications to a supervisor. 4. ... when the outreach worker or health care provider AND the patient co-sign that the medication was ingested and that toxicity was denied by the patient. 5. ... when outreach workers or health care providers report DAILY, to their supervisor, those DOT/DOPT doses successfully administered as well as those that were missed. If financial assistance is needed for special DOT/DOPT situations, please contact TB Elimination at (512) 458-7447. DOT/DOPT IS NOT... 1. ... allowing a family member or friend to supervise and observe a patient taking the prescribed medication without the DOT worker being present. 2. ... allowing a parent or guardian to administer medication to a child or adolescent without the DOT worker present. 3. ... allowing an inmate in a correctional institution to swallow a dose of medication without observation. 4. ... leaving medication at the patient's homesite when the patient is not present. 5. ... leaving the medication at the patient's bedside in a hospital, nursing home or other medical facility. 6. ... dispensing medication and "verifying" ingestion by performing a weekly pill count. 7. ... permitting medical professionals (physicians & nurses) to self-administer their medications. For answers to questions regarding DOT/DOPT policy and practice, please contact Marilyn Metcalf, also at (512) 458-7447.