During the 45th Union World Conference on Lung Health in Barcelona, Spain on 28 October to 1 November 2014, a great deal of attention was paid to the importance of the integration of the social support services with the medical package of services for TB patients.
From 2006 on, DOT is not the only strategy of TB control recommended by WHO, as was stated by Dr. Ernesto Jaramillo, WHO. New concepts in global TB strategy are zero suffering and no families suffering from the bankrupt costs.
“Zero suffering” relates to the quality of life, which is much more complex than just the directly observed treatment mechanism. Therefore, holistic and comprehensive approach to achieve mortality and incidence targets by 2035 with an associated 95% decline in TB deaths, a 90% decline in TB incidence, and the elimination of catastrophic costs for TB-affected households is needed.
DOT is justifiable only when it is a part of a comprehensive patient-centered approach, which implies minimizing both the burdens of disease and the burdens of care on patients; avoiding stigmatization, and giving patients choices about who will observe them.
Clearly explaining to the patient what will happen if the patient is not adherent is a key element, because TB adherence to treatment is not the same as the adherence to other treatments that may not be fatal.. It is important for health care providers to ask the patient: “What help do you need from me to adhere to treatment?”, as the adherence is both the responsibility of the patient and of the health care provider.