ABSTRACT
The World Health Assembly (WHA) resolution of 1991, recognizing tuberculosis (TB) as a major global public health problem, reinvigorated global efforts to control TB and established, for the first time, clear targets to be reached by all countries (1). In 1994, the internationally recommended control strategy, later named DOTS, was launched (2). Its key components included: government commitment; case detection by predominantly passive case finding; standardized short-course chemotherapy for (at least) all confirmed sputum smear-positive cases, provided under proper case management conditions; a system of regular drug supply; and a monitoring system for program supervision and evaluation. The DOTS framework has subsequently been expanded (3), further clarified, and implemented in 182 countries. DOTS implementation has helped countries to improve National TB Programs (NTPs) and make major progress in TB control. By 2004, over 20 million patients had been treated in DOTS programs worldwide and over 16 million of them had been cured. Mortality due to TB has been declining and incidence diminishing or stabilizing in all world regions except
sub-Saharan Africa and, until recently, Eastern Europe. The global treatment success rate among new smear-positive TB cases has reached 83% (just short of the WHA target of 85% by 2005), and in 2004, the case-detection rate was 53% (against the target of 70% by 2005). However, the case-detection rate has accelerated globally since 2001 (4).
