Effectiveness of the DOTS Program in Enhancing Management of Pulmonary Tuberculosis: A Systematic Review

Abstract

Background: The Directly Observed Therapy Short-Course (DOTS) program is a key strategy for managing pulmonary tuberculosis (PTB) by ensuring treatment adherence and improving patient outcomes. The effectiveness of the DOTS program in improving management of PTB patients was evaluated through a systematic review.

Methods: A systematic review methodology was employed to identify and analyze relevant studies published between 2019 and 2024, focusing on the effectiveness of interventions for tuberculosis management. The review utilized seven major databases—ScienceDirect, Scopus, ProQuest, EBSCOhost, Sage Journals, Taylor & Francis, and PubMed—searched with a well-defined strategy and Boolean operators to ensure comprehensive coverage of the literature. Studies were selected based on established inclusion and exclusion criteria. For quality appraisal, the Joanna Briggs Institute (JBI) checklist was used to assess quasi-experimental studies, while the ROBVIS tool was applied to evaluate the risk of bias in randomized controlled trials. The review adhered to the Synthesis Without Meta-Analysis (SWiM) guidelines for data analysis to ensure a transparent and structured synthesis of findings. Additionally, the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was utilized to guide the final appraisal and reporting of the selected articles.

Results: Three studies (quasi-experimental and RCT) conducted in Uganda and India, with intervention durations ranging from 6 to 8 months, demonstrated significant improvements in pulmonary tuberculosis (PTB) treatment outcomes. The studies, reviewed from a pool of 13,495 articles, exhibited an overall low risk of bias. Strategies such as DOTS and herbal adjuncts like Rudanti (Capparis moonii) were effective in enhancing treatment efficacy, alleviating drug-induced hepatotoxicity, and improving symptom relief. Also, the integration of digital adherence technologies (DATs), such as 99DOTS, has shown great promise in boosting treatment compliance through mobile-based solutions.

Conclusion: The DOTS program has significantly improved TB management by ensuring treatment adherence, reducing drug resistance, and achieving high cure rates. Despite challenges like resource demands and logistical issues, it remains a cornerstone in TB control. Innovations such as digital adherence tools and adjunct therapies are enhancing its impact which provide solutions for better patient outcomes and broader TB eradication efforts.