Managing the epidemic of TB

The first priority in managing the current upsurge of TB is to ensure that there are health services in place that are sustainable long term. It can be argued that starting a TB control programme that fails after a certain period is worse than never having started one at all, because a failed programme leaves as its legacy patients with drug-resistant bacilli. For example, MSF sometimes chooses not to start TB treatment in an unstable refugee situation, where it is likely that the population will move and be lost to follow-up. What we do instead is plan and wait until the situation stabilises. DOTS - or directly observed treatment, short course - has been adopted by the World Health Organisation as a global strategy. According to previous strategies, patients were given a week or even a month's supply of TB medicines and told to come back at the end of that period for more. Often they did not take the medicines, and often they did not return. With the DOTS strategy, however, health workers are required to give each patient only their daily dose of medication and watch while they actually swallow it. They must also monitor progress until the treatment course is finished and the patient is free of tubercle bacilli. Curing the disease is thus the responsibility of the health worker, not the patient. WHO has set a goal for TB control programmes to cure 85 per cent of detected new active TB cases and detect 70 percent of estimated cases. DOTS is likely to be the only strategy to have any hope of achieving these targets.