According to WHO, the most cost-effective way to stop the spread of TB in communities with a high incidence is by curing it. The best curative method for TB is known as DOTS. One of its components is:

1. A

   standardised treatment regimen directly of eighteen months observed by a healthcare worker

2. B

   patients will buy the drugs

3. C

   case detection by sputum smear microscopy

4. D

   health for All by 2000 AD

Appeared in: AIIMS Jodhpur SNO-2023

Explanation

• DOTS (Directly Observed Treatment, Short-course) is the WHO-recommended strategy for effective TB control.
• A cornerstone of this strategy is quality-assured diagnosis, which relies on case detection through sputum smear microscopy among patients showing symptoms of TB.
• This method is crucial because it identifies bacteriologically confirmed, infectious cases, allowing for targeted treatment that interrupts the chain of transmission in the community.
• The other components of DOTS include political commitment, supervised treatment, a reliable drug supply, and a robust monitoring system.

Why Other Options Were Wrong

• Option A: The standard DOTS regimen is a 'short-course' therapy, typically lasting 6 to 9 months. An eighteen-month duration is incorrect for standard, newly diagnosed TB.
• Option B: A key principle of the DOTS strategy is to ensure an uninterrupted supply of anti-TB drugs, which are provided free of cost to the patient. This removes financial barriers and promotes treatment adherence.
• Option D: 'Health for All by 2000 AD' was a global health slogan and goal originating from the Alma-Ata Declaration of 1978, focusing on primary healthcare. It is a separate initiative and not a specific component of the DOTS strategy for TB.

Related Visual

• Visual 1: Flowchart: The 5 Components of the DOTS Strategy. This visual would clearly outline each of the five pillars (Political Commitment, Diagnosis, Treatment, Drug Supply, Monitoring) for easy memorization.
• Visual 2: Infographic: Sputum Smear Microscopy Process. This would illustrate the steps from sputum collection to microscopic examination, highlighting what the technician looks for (acid-fast bacilli).

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Components of the DOTS (Directly Observed Treatment, Short-course) strategy for Tuberculosis (TB) control as background academic context rather than a clinical decision trigger.
• Nurses are central to the success of the DOTS program. They are often the 'observers' who ensure patients take their medication, provide patient education about the disease and treatment, monitor for side effects, and offer psychosocial support.
• Failure to adhere to the full course of TB treatment is a major public health risk, as it can lead to treatment failure, relapse, and the development of Multi-Drug Resistant TB (MDR-TB), which is much harder and more expensive to treat.
• What if? If a patient's sputum smear is negative but they still have strong clinical signs of TB (like persistent cough, weight loss, and an abnormal chest X-ray), the nurse should anticipate that further diagnostic tests, such as a nucleic acid amplification test (NAAT) like CBNAAT/GeneXpert, will be ordered to confirm the diagnosis.

How to Approach the Question

• First, identify the core of the question: it asks for a specific component of the 'DOTS' strategy for TB.
• Recall the meaning of the acronym DOTS: 'Directly Observed Treatment, Short-course'. This immediately helps evaluate the options.
• Analyze Option A: 'eighteen months' contradicts the 'Short-course' part of the acronym. Eliminate it.
• Analyze Option B: 'patients will buy the drugs' goes against the public health principle of ensuring access and adherence, which is central to controlling an infectious disease like TB. Eliminate it.
• Analyze Option D: 'Health for All by 2000 AD' sounds like a broad health policy goal, not a specific component of a disease control strategy. It's from a different era and context. Eliminate it.
• Analyze Option C: 'case detection by sputum smear microscopy' is a logical first step in any treatment program – you must first find the cases. This is a well-established method for TB diagnosis and fits within a structured control program. This is the most plausible component.

Concept Tested & Keywords

• Concept Tested: Components of the DOTS (Directly Observed Treatment, Short-course) strategy for Tuberculosis (TB) control.
• Stem keywords: WHO, TB, DOTS, curative method, component
• Lead-in keywords: One of its components is
• Negative lead-in flag: false

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QDYESSr8dmqVbtFJQ9vHVN

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