Tuberculosis control in resource-poor countries: have we reached the limits of the universal paradigm?
The aim of TB control is to break the cycle of transmission by treating TB cases as early and efficiently as possible. In its efforts to promote a model of worldwide TB control, WHO defined specific targets and launched the 'Directly Observed Therapy, Short-course' (DOTS) strategy as the main tool to reach them. However, the diversity of patients' attitudes towards the disease and the extreme variability of access to care, especially in resource-poor countries, are amongst the many factors of social context that profoundly affect the ability of control programmes to implement this policy effectively. There are multiple reports of TB control programmes using various types of intervention to promote adherence and enhance case-holding, but most of these interventions depend on external funding, which bring into question their long-term sustainability. In this paper, we address the problems related to operational variabilities in the implementation of the DOTS strategy in resource-poor countries and question the appropriateness of a universal paradigm for global TB control. This analysis is of particular importance as programmers consider using this model in the delivery of anti-retroviral therapies for the treatment of HIV in resource-limited settings.
Lienhardt
Christian
C
Institut de Recherche pour le Développement, Dakar, Sénégal. lienhardt@dakar.ird.sn
Ogden
Jessica Ann
JA
D001294:Attitude to Health; D003906:Developing Countries; D005381:Financing, Organized; D006297:Health Services Accessibility; D006801:Humans; D010348:Patient Care Team; D010349:Patient Compliance; D011314:Preventive Health Services / Q000191:economics / Q000458:organization & administration*; D014376:Tuberculosis / Q000191:economics / Q000517:prevention & control*