eDOTS = enhancing DOTS

Based on IDP's cumulative experience in working with local District health partners in the context of rural Uganda, East Africa, an intervention emerged to overcome the obstacles in controlling and abating Tuberculosis (TB). Termed "eDOTS", this IDP GHS Program is an electronic equivalent to DOTS, the standard protocol developed by the World Health Organization (WHO) for treating and controlling TB worldwide. DOTS stands for Directly Observed Treatment Short-course, which emphasizes watching the infected patient take his or her medication every day for several months.

Characterized as an eHealth intervention, the GeoHealth Systems eDOTS Program enables high burden countries to better achieve WHO goals of success and identification rates. This will achieve the objectives to reduce the mortality, morbidity and transmission of TB and prevent TB drug resistance.

However, to be successful, a DOTS program requires intense patient monitoring, especially during the initial months of treatment while the patient is still infectious. In countries like Uganda, where there is always a shortage of qualified health workers managing far too many patients, the biggest problem is tracking and monitoring TB patients to ensure they comply with their treatment regimen. Through the eDOTS program, infectious patients are quickly turned noninfectious, thus breaking the cycle of transmission.

The added value of the GHS eDOTS program, which supplements and improves the local health service delivery sector, includes the following: telemedicine, web-based database, interactive health / education media, improved and expanded surveillance, testing, diagnosis, reporting, treatment, TB Contact Investigations, standardized health worker training, a more comprehensive Social Ecology implementation framework, increased participation of key stakeholders, and increased mobility to reach remote, at-risk, and undeserved populations.

The first phases of the program in Uganda have demonstrated the feasibility of utilizing the eDOTS Program for TB surveillance, reporting, prevention and control activities in rural settings lacking sufficient infrastructure and capacity for effective control and prevention efforts. The large and frequently daunting geographical areas within rural Ugandan Districts creates an immense challenge at meeting the WHO DOTS protocol goals and reporting, and the eDOTS electronic platform effectively improves these circumstances.

Outcomes of the GHS eDOTS Program are improved sharing and management of patient information throughout the TB control sector. Near real-time monitoring and evaluation of overall TB program goal and objectives are made possible through the web-enabled eDOTS database, where all select indicators are compiled into report pages for TB program managers, ensuring overall program information is readily available for monitoring and evaluation, including improved reporting to the Ministry of Health.

Through the successes of the intervention, IDP seeks to establish a model that will lead to the implementation of the program through the whole of Uganda, reducing TB morbidity while simultaneously increasing the local capacity to collaboratively support ongoing TB control and prevention efforts.

IDP will work closely with the Ugandan Ministry of Health (MoH) and the National Tuberculosis and Leprosy Program (NTLP) in these expansion activities.

Upon expansion of the program within Uganda, IDP will work closely with the Kenya Medical Research Institute (KEMRI) not only to implement the GHS eDOTS within Kenya, but also for the purpose of expansion throughout the whole of East Africa. IDP, having entered into a Memorandum of Understanding with KEMRI in November of 2002, has already set the foundation for the successful implementation and roll-out of this approach.

IDP is currently working with various organizations to implement eDOTS programs in Kyrgyzstan, Mexico and the Marshall Islands of the Pacific Ocean. The implementation of these projects is a direct result of the successes and lessons learned from Uganda.