[Outcomes and problems of DOTS strategy in Japan].

The DOTS strategy promoted by the World Health Organization (WHO) was applied in 183 countries in 2004. The DOTS coverage, defined as the percentage of the population living in areas where health services have adopted DOTS, was 83% globally in 2004, but it was 71% in Japan. The global 2005 targets for tuberculosis (TB) control are to detect at least 70% of infectious TB cases and cure 85% of those cases detected. According to the most recent WHO annual report, the DOTS case detection rate in 2004 was 45% in Japan whereas the global average of it was 53%. The treatment success rate, defined as the percentage of patients (in the 2003 cohort) who are cured or who complete treatment, was 82% globally, but it was 76% in Japan. This relatively low achievement is attributed to the fact that public health centers in some districts operated insufficient monitoring system for evaluation of the treatment outcome by cohort analysis. However, the treatment success rate will not be improved easily because more than half of new TB patients in Japan are old people who tend to have various complications. The Ministry of Health, Labour and Welfare demonstrated the framework of the DOTS Japan version in 2003 to promote the DOTS strategy with collaboration between hospitals, public health centers and welfare organization. The new strategy includes the program for treatment of TB inpatients and the community-based program for outpatients. The latter program called "community DOTS" is classified into three types according to the risk of treatment interruption with an individual patient. The Japanese Society for Tuberculosis should urge the government (at central and regional levels) to enhance political commitment to accelerate activities for TB elimination. It is necessary that the central government build a new public funding system to improve the cure rate under the DOTS Japan version. The local government should strengthen the function of public health centers not only to secure the quality of monitoring system for evaluation of the treatment outcome but to develop human resources who are able to collaborate with public health nurses in promoting the community-based DOTS program.