PMID- 12758187
OWN - NLM
STAT- MEDLINE
DCOM- 20030805
LR  - 20191107
IS  - 1472-9792 (Print)
IS  - 1472-9792 (Linking)
VI  - 83
IP  - 1-3
DP  - 2003
TI  - What is the limit to case detection under the DOTS strategy for tuberculosis 
      control?
PG  - 35-43
AB  - In year 2000, the WHO DOTS strategy for tuberculosis (TB) control had been 
      adopted by 148 out of 212 countries, but only 27% of all estimated sputum 
      smear-positive patients were notified under DOTS in that year. Here we 
      investigate the way in which gains in case detection under DOTS were made up 
      until 2000 in an attempt to anticipate future progress towards the global target 
      of 70% case detection. The analysis draws on annual reports of DOTS geographical 
      coverage and case notifications, and focuses on the 22 high-burden countries 
      (HBCs) that account for about 80% of new TB cases arising globally each year. Our 
      principal observation is that, as TB programmes in the 22 HBCs have expanded 
      geographically, the fraction of the estimated number of sputum smear-positive 
      cases detected within designated DOTS areas has remained constant at 40-50% 
      although there are significant differences between countries. This fraction is 
      about the same as the percentage of all smear-positive cases notified annually to 
      WHO via public health systems worldwide. The implication is that, unless the DOTS 
      strategy can reach beyond traditional public health reporting systems, or unless 
      these systems can be improved, case detection will not rise much above 40% in the 
      22 HBCs, or in the world as a whole, even when the geographical coverage of DOTS 
      is nominally 100%. We estimate that, under full DOTS coverage, three-quarters of 
      the undetected smear-positive cases will be living in India, China, Indonesia, 
      Nigeria, Bangladesh and Pakistan. But case detection could also remain low in 
      countries with smaller populations: in year 2000, over half of all smear-positive 
      TB cases were living in 49 countries that detected less than 40% of cases within 
      DOTS areas. Substantial efforts are therefore needed (a) to develop new case 
      finding and management methods to bridge the gap between current and target case 
      detection, and (b) to improve the accuracy of national estimates of TB incidence, 
      above all by reinforcing and expanding routine surveillance.
FAU - Dye, Christopher
AU  - Dye C
AD  - Communicable Diseases, World Health Organization, 1211 Geneva 27, Switzerland. 
      dyec@who.int
FAU - Watt, Catherine J
AU  - Watt CJ
FAU - Bleed, Daniel M
AU  - Bleed DM
FAU - Williams, Brian G
AU  - Williams BG
LA  - eng
PT  - Journal Article
PL  - Scotland
TA  - Tuberculosis (Edinb)
JT  - Tuberculosis (Edinburgh, Scotland)
JID - 100971555
RN  - 0 (Antitubercular Agents)
SB  - IM
MH  - Antitubercular Agents/*therapeutic use
MH  - Developing Countries
MH  - *Directly Observed Therapy/statistics & numerical data
MH  - Humans
MH  - Incidence
MH  - National Health Programs/standards
MH  - Tuberculosis, Pulmonary/*diagnosis/epidemiology/*prevention & control
EDAT- 2003/05/22 05:00
MHDA- 2003/08/06 05:00
CRDT- 2003/05/22 05:00
PHST- 2003/05/22 05:00 [pubmed]
PHST- 2003/08/06 05:00 [medline]
PHST- 2003/05/22 05:00 [entrez]
AID - S1472979202000562 [pii]
AID - 10.1016/s1472-9792(02)00056-2 [doi]
PST - ppublish
SO  - Tuberculosis (Edinb). 2003;83(1-3):35-43. doi: 10.1016/s1472-9792(02)00056-2.