Beyond DOtS: avenues ahead in the management of tuberculosis.

India has almost 30% of the global burden of tuberculosis (TB)--one person dies of the disease every minute in our country. India has mounted the second-largest DOTS programme in the world to control this disease. However, DOTS has its limitations and newer approaches have been developed over the years to overcome the global burden of tuberculosis. Problems with health facilities, patients, drugs and the disease itself constitute some of the hurdles in the implementation of the DOTS programme. In an attempt to go beyond DOTS, the WHO launched the 'Stop TB Initiative' in 1988. Against the background of irrational antituberculosis drug use, which contributes to increasing drug resistance, the effective involvement of private healthcare providers is imperative to achieve better geographical and patient coverage for the implementation of DOTS. The WHO is currently addressing the issue of involving private practitioners in tuberculosis control in a programme called Public-Private Mix DOTS (PPM DOTS). The Stop TB Initiative is also active in the area of dual infection with HIV and tuberculosis, and the initiatives that have been taken in this area include 'ProTEST', community contribution to tuberculosis care, and development and dissemination of training materials and guidelines. The DOTS-Plus strategy for the management of multidrug resistant (MDR)-TB and the establishment of the Green Light Committee to review project applications in this area are initiatives taken to curb the problem of drug resistance in tuberculosis. Even decades after the introduction of the DOTS strategy, much needs to be done to expand the services to the entire population; it is now essential to develop strategies that go beyond DOTS.