title: Non-clinical factors associated with TB: important for DOTS impact evaluation and disease elimination.
abstract: Initial optimism that DOTS (Directly Observed Treatment, Short-course) would have a dramatic effect on TB incidence rates in developing countries has not been supported by the evidence accumulated so far. Indeed, where TB incidence rates have decreased, non-clinical socio-economic factors appear to have played at least as great a role. We postulate that in those settings with little or no decrease in TB incidence, there are likely to be common pathway blockages that interfere with the effectiveness of DOTS implementation as socio-economic factors evolve. Measuring socio-economic trends, as well as DOTS implementation, is important for understanding TB control and opens up the opportunity for broader public health engagement.
authors: Centre for International Health and the Otago International Health Research Network, Department of Preventive and Social Medicine, University of Otago School of Medicine, PO Box 56, Dunedin 9054, New Zealand philip.hill@otago.ac.nz.
authors: Philip C
authors: PC
authors: Hill
authors: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Health Sciences Campus, 101 Buck Road, Athens, Georgia 30602, USA.
authors: Christopher C
authors: CC
authors: Whalen
mesh_terms: D000995:Antitubercular Agents / Q000191:economics / Q000627:therapeutic use*; D003140:Communicable Disease Control / Q000191:economics / Q000458:organization & administration*; D003906:Developing Countries / Q000191:economics; D023801:Directly Observed Therapy / Q000191:economics; D060740:Disease Eradication; D006801:Humans; D015994:Incidence; D011634:Public Health / Q000191:economics; D012959:Socioeconomic Factors; D014376:Tuberculosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000995:Antitubercular Agents
keywords: DOTS; Disease elimination; Tuberculosis