Connecting the DOTS: Should we still be doing directly observed therapy?

Since the 1960s, the primary approach to treating tuberculosis (TB) worldwide has been directly observed therapy (DOT) (taking medication under supervision). Drawing on ethnographic data from Romania, literature on DOT globally and a human rights-based analysis, I argue that in many places DOT is not occurring as intended, and that it is ineffective, onerous to the people being treated and in conflict with their human rights. Instead, DOT should be one of several types of adherence supports from which people can choose within a rights-based and person-centered treatment that serves their varied needs through their long and difficult TB treatment.