Limitation of DOTS
High Prevalence of HIV/AIDS
・HIV/AIDS can greatly increase the rate of TB in a community
・One-third of TB patients dies during treatment if they have HIV infection
・In parts of Africa where effective DOTS program has been in place for years, the HIV/AIDS epidemic has led to dramatic increases in TB cases and deaths
・Current DOTS strategy cannot effectively control TB in areas with high prevalence of HIV infection
・But without DOTS, the TB situation in these areas would be much worse; DOTS has blunted the increase in TB cases and prevented a drug-resistant epidemic
Limitation of DOTS
Poorly Functioning Health System
Effective DOTS implementation depends on a functioning health system
・With a poorly functioning health system, the technical elements of DOTS is difficult to implement well, even if funds are available for the program itself
