Tuberculosis control--is DOTS the health breakthrough of the 1990s?

The Directly Observed Treatment Short-course (DOTS) therapy against tuberculosis (TB) adopted by the World Health Organization (WHO) 5 years ago has proven to be highly effective in curing and controlling the spread of TB. DOTS now needs to be used worldwide on a much larger scale. More than 1.2 million people worldwide have been treated with DOTS since it was adopted by WHO 5 years ago as the preferred strategy against TB. Most patients have been young and middle-aged adults of whom more than 900000 had the infectious smear-positive form of the disease. Had these patients had access to only the treatment previously available in their countries many would have certainly died and many more would have become chronic cases spreading the disease in their communities. Such chronic cases resulting from poor or interrupted treatment become the main source of drug-resistant TB strains. The following components must be in place in order to launch a successful DOTS program: a network of trained workers able to administer DOTS for at least the first 2 months; laboratories with personnel trained and equipped to recognize tubercle bacilli in sputum smear samples; a dependable supply of high-quality drugs; an accurate record-keeping and cohort analysis system for monitoring case-finding treatment and outcomes; and sustained political commitment and funding.