Directly observed therapy and treatment adherence

Lancet. 2000 Apr 15;355(9212):1345-50. doi: 10.1016/S0140-6736(00)02124-3.


Direct observation of patients taking their medication is a strategy to improve completion rates for tuberculosis treatment, but the programmes to implement this approach consist of a complex array of inputs aimed at influencing adherence. Policy makers need a clear understanding of these inputs to succeed. We systematically identified and reviewed published reports of direct observation therapy (DOT) programmes and compared inputs with WHO's short-course DOT programme. DOT programmes frequently consist of more than the five elements of WHO's strategy, including incentives, tracing of defaulters, legal sanctions, patient-centred approaches, staff motivation, supervision, and additional external funds. Focusing on direct observation as a key factor in the promotion of adherence seems inappropriate. Multiple components might account for the success of DOT programmes, and WHO should make these explicit.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antitubercular Agents / administration & dosage*
  • Communicable Disease Control / legislation & jurisprudence
  • Health Policy / legislation & jurisprudence
  • Humans
  • Patient Care Team* / legislation & jurisprudence
  • Patient Compliance*
  • Program Evaluation
  • Tuberculosis / drug therapy*
  • World Health Organization


  • Antitubercular Agents