Is the DOTS strategy sufficient to achieve tuberculosis control in low- and middle-income countries? 2. Need for interventions among private physicians, medical specialists and scientific societies.
In the first of these two articles it was expressed how, in practically all middle-income and many low-income countries, it is necessary to implement interventions in addition to the DOTS strategy if adequate tuberculosis control is to be achieved. We need to act in two directions: 1) in universities and medical schools, as explained in the first article, and 2) specifically among private physicians and medical specialists, an important obstacle for many National Tuberculosis Programmes (NTPs). These professionals, especially medical specialists (many of whom also work in private practice), are an influential sector that is held in high regard, but which tends not to follow guidelines considered as excessively simplistic or rigid, such as those stipulated by the NTP. Private physicians have practically no access to information or training programmes, which accounts for the surprising disparity in their clinical criteria. All this leads to important distortions that can compromise the NTP's outcome. The present article evaluates the need to intervene among private physicians and medical specialists in order to achieve better tuberculosis control. Special strategies are described to obtain concrete, specific agreements for their participation in the NTP, and for the implementation of specific training programmes for this group. At the end of the article the work performed by the IUATLD in these groups in Latin America is described.
Caminero
J A
JA
International Union Against Tuberculosis and Lung Disease, Paris, France. jcaminer@separ.es
D003906:Developing Countries; D023801:Directly Observed Therapy; D004501:Education, Medical; D004502:Education, Medical, Continuing; D006078:Government Programs; D007843:Latin America; D011331:Private Practice; D012958:Societies, Scientific; D013038:Specialization; D014376:Tuberculosis / Q000517:prevention & control*