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    139292
    Peer Reviewed

    Prospects for worldwide tuberculosis control under the WHO DOTS strategy.

    Dye C; Garnett GP; Sleeman K; Williams BG

    Lancet. 1998 Dec 12; 352(9144):1886-91.

    Short-course chemotherapy is currently the most effective treatment for most patients with tuberculosis (TB), and direct observation helps many patients complete the 6-8 month treatment regimen. Passive case finding is recommended for a number of reasons. The authors developed an age-structured mathematical model to explore the characteristics of TB control under the World Health Organization (WHO)-recommended directly-observed treatment, short-course (DOTS) strategy, and to forecast the effect of improved case finding and cure upon TB epidemics for each of the 6 WHO regions. In countries in which the incidence of TB is stable and HIV-1 absent, a control program which reaches the WHO targets of 70% case detection and 85% cure would reduce the incidence rate of TB by 11% per year and the death rate by 12% per year. However, if the incidence of TB has been declining for some years, the same case detection and cure rates would have a smaller effect upon incidence. DOTS saves a greater proportion of deaths than cases, and that difference is larger in the presence of HIV-1. HIV-1 epidemics cause an increase in TB incidence, but do not substantially reduce the preventable proportion of cases and deaths. Without more active efforts to control TB, the annual incidence of the disease is expected to increase by 41% between 1998 and 2020, from 7.4 to 10.6 million cases per year. Achieving WHO targets by 2010 would, however, prevent 23% of cases by 2020.
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