Tuberculosis control in resource‐poor countries: have we reached the limits of the universal paradigm?

Abstract

SummaryThe aim of TB control is to break the cycle of transmission by treating TB cases as early and efficiently as possible. In its efforts to promote a model of worldwide TB control, WHO defined specific targets and launched the 'Directly Observed Therapy, Short-course' (DOTS) strategy as the main tool to reach them. However, the diversity of patients' attitudes towards the disease and the extreme variability of access to care, especially in resource-poor countries, are amongst the many factors of social context that profoundly affect the ability of control programmes to implement this policy effectively. There are multiple reports of TB control programmes using various types of intervention to promote adherence and enhance case-holding, but most of these interventions depend on external funding, which bring into question their long-term sustainability. In this paper, we address the problems related to operational variabilities in the implementation of the DOTS strategy in resource-poor countries and question the appropriateness of a universal paradigm for global TB control. This analysis is of particular importance as programmers consider using this model in the delivery of anti-retroviral therapies for the treatment of HIV in resource-limited settings.keywords directly observed therapy, tuberculosis control

Detection of Mycobacterium tuberculosis and Drug Resistance: Opportunies and Challenges in Morocco

“…A total of 180 countries (including both developed and developing countries) had adopted and implemented the DOTS strategy by the end of 2002 and 69% of the global population are living in areas covered by the DOTS strategy (Blumberg, 2003). However, even though DOTS programs are in place, treatment success rates are very low in low income countries due to poor management of TB control programs and patient non-compliance (Lienhardt and Ogden, 2004;Bastian, 2003). Furthermore, the effectiveness of DOTS is facing new challenges with respect to the spread and increase of MDR-TB and the co-epidemic of TB/HIV (WHO, 2003).…”

Drug Resistance inMycobacterium tuberculosis

“…A total of 180 countries (including both developed and undeveloped countries) had adopted and implemented the DOTS strategy by the end of 2002 and 69% of the global population was living in areas covered by the DOTS strategy (Blumberg et al, 2003). However, even though DOTS programs are in place, treatment success rates are very low in developed countries due to poor management of TB control programs and patient non-compliance (Lienhardt and Ogden, 2004;Bastian et al, 2003). Furthermore, the effectiveness of DOTS is facing new challenges with respect to the spread and increase of MDR-TB and the co-epidemic of TB/HIV (World Health Organization, 2003).…”

Desempenho de serviços de saúde no tratamento diretamente observado no domicílio para controle da tuberculose

“…It becomes, then, essential to advance into a multidisciplinary approach and explore psychological and socio-economic determinants of the disease, so as to help develop appropriate and effective interventions for detection and treatment of cases, looking at the patient within the community context and reaching patients who are motivated to solve their healthcare problems, instead of those concerned only with finding better ways to take their medication (9) .…”