Effectiveness and challenges of DOT in multidrug-resistant TB: a 12-year retrospective study

SETTING: TB remains a major public health problem in Pakistan, a high-burden country with a high prevalence of multidrug-resistant TB (MDR-TB). Directly Observed Treatment (DOT) is widely used to improve treatment adherence; however, provincial-level evaluations remain limited, particularly in Sindh. OBJECTIVE: To assess the effectiveness, outcomes, and challenges of DOT in Sindh Province over a 12-year period. A retrospective observational study was conducted including all patients enrolled in the National DOT Programme in Sindh from 2010 to 2022. Demographic, clinical, and treatment data were evaluated. RESULTS: Pulmonary MDR-TB was highly prevalent among individuals aged 16-35 years. Extensively drug-resistant TB (XDR-TB) accounted for 6.32% of cases and pan drug-resistant TB (PDR-TB) for 0.32%. Before enrolling into DOT, most patients (48.35%) had treatment outcomes that were not evaluated or had failed treatment (38.45%) in their previous non-DOT therapy. DOT achieved cure rates of 68% for long-term regimens and 75% for short-term regimens, with timely sputum conversion. CONCLUSION: DOT was effective for managing MDR-TB; however, high MDR-TB prevalence, delayed diagnosis, treatment-related side effects, and patient loss to follow-up emphasise the need for strengthened early detection, adherence support, and monitoring strategies to improve treatment outcomes.