The DOTS strategy in China: results and lessons after 10 years.
OBJECTIVE
To analyse the five-point tuberculosis (TB) strategy, DOTS, 10 years after its implementation in one-half of China's population, and to suggest lessons for future implementation of the DOTS strategy.


METHODS
We analysed trends in case-finding and treatment outcome over time following implementation of the DOTS strategy in each county, using routine reporting data from the Infectious and Endemic Disease Control (IEDC) project (1991 - 2000). We also determined the proportion of counties with different levels of case-finding for the fifth and sixth years of DOTS implementation.


RESULTS
From 1991 to 1995, DOTS expanded rapidly to cover more than 90% of target population and counties. By 2000, 8 million TB suspects had received free diagnostic evaluation: 1.8 million TB cases were diagnosed, free treatment was provided to 1.3 million smear-positive cases, and more than 90% were cured. During DOTS implementation, the percentage of previously treated cases decreased among all smear-positive cases and treatment outcomes improved. Despite these achievements, the detection rate for new smear-positive cases in the project was estimated to be only 54% in 1998, and 41.2% of the counties had a below average or low level of case-finding (with substantial variation between provinces).


CONCLUSIONS
The IEDC project demonstrated that it is feasible to rapidly expand DOTS on a large scale. The global target of an 85% cure rate was quickly achieved, and the level of drug-resistance was probably reduced by this project. However, case-detection did not reach the 70% global target, and more research is needed on how to enhance this.
Xianyi
Chen
C
Disease Control Department, Ministry of Health, Beijing, China.
Fengzeng
Zhao
Z
Hongjin
Duanmu
D
Liya
Wan
W
Lixia
Wang
W
Xin
Du
D
Chin
Daniel P
DP
D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002681:China / Q000453:epidemiology; D003140:Communicable Disease Control / Q000458:organization & administration*; D023801:Directly Observed Therapy; D018563:Disease Notification / Q000706:statistics & numerical data; D004352:Drug Resistance, Microbial; D006284:Health Plan Implementation; D006801:Humans; D011159:Population Surveillance; D015397:Program Evaluation; D015980:Public Health Practice; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D014480:United Nations; D014944:World Health Organization
D000995:Antitubercular Agents