Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

DOT Regimens
The Alaska TB Program recommends the use of TB treatment regimens contained in the
Treatment of Tuberculosis Disease section (6.6 – 6.12). When DOT is used, drugs may
be given five (5) days a week and will be considered to be daily dosing 72 The Alaska TB
Program does not expect that TB medications will be provided by DOT Aides, PHNs, or
others on weekends and will only provide payment to DOT Aides for up to 5 doses of
anti-TB medications per patient each week unless pre-approved.
Payment for DOT Services
PHN staff is never paid to provide DOT to patients; it is considered part of their job
duties. Similarly, in situations where CHAPs administer DOT during their normal work
hours they should not be offered payment for DOT. When CHAPs make home visits or
meet the patient for DOT after hours or during their lunch break, they may be eligible for
DOT payment if arranged in advance with the Alaska TB program. The Alaska TB
Program provides payment to DOT Aides for each day they deliver and observe the
patient swallow their TB medications.
Funding for DOT aides is very limited and must be used wisely. Patients with active TB
disease remain the first priority for DOT. However, certain individuals with LTBI should
also be considered for DOT based on the risks described above. All individuals on the
12-week INH/RPT regimen for LTBI must have DOT.
Use the DOT Aide Job Description, DOT Aide Memorandum of
Agreement, DOT Calendar, and DOT Monthly Invoice for Payment (18.1)
to document activities. Send copies of the completed DOT Calendar and
DOT Monthly Invoice for Payment to the Alaska TB Program to request
monthly payment for DOT services.
The Alaska TB Program will only provide payment to DOT Aides for
up to 5 doses of anti-TB medications per patient each week unless
pre-approved. If the provider wants medications to be taken 7 days a
week, it is acceptable for most patients to self administer weekend doses.
Only doses delivered by DOT will be counted to determine the completion
of treatment date.
Principles of Directly Observed Therapy
• The healthcare worker or DOT Aide should watch the patient swallow each dose
of medication.
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ALASKA TB PROGRAM MANUAL Case Management 10.36
Revised November 2012