DOTS expansion: will we reach the 2005 targets?

The global targets for tuberculosis control consist of detecting 70% of estimated infectious cases and curing 85% of these by 2005. Since the introduction of the DOTS strategy, DOTS geographical coverage has increased substantially and treatment success rates under DOTS are approaching the targets, standing at 82% in 2000. However, DOTS case detection, albeit increasing, is still relatively low, at 32% in 2001. This target may not be reached by 2005. The low case detection is unlikely to stem from overestimating the global number of TB cases which has been estimated on several occasions, but from TB cases not being detected or notified for various reasons. The population may have poor access to TB services, cases may not be suspected or correctly diagnosed, cases may not be notified, and/or public health programmes or the private sector may not be adequately linked to the National Tuberculosis Programmes. Since the global TB targets were set, progress has been made. Political commitment has increased, additional financial resources mobilised, access to anti-tuberculosis drugs augmented and planning and coordination improved. Constraints still remain, the most important related to human resource capacity. Although the issue is being tackled, many countries still suffer from a lack of trained health care professionals. Finally, new strategies have been developed to face the current challenges such as public-private mix, community TB care, social mobilisation, TB/HIV collaborative interventions and Practical Approach to Lung Health. The current efforts should be maintained and strengthened in order to approach these targets.