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Anti-tuberculosis Drug Resistance in the World
Report No. 2
The WHO/IUATLD Global Project on Anti-tuberculosis Drug Resistance Surveillance 19972000
2000, 240 pages [E]
Sw.fr. 25./US $22.50; in developing countries: Sw.fr. 17.50
Order no. 1932117
| Fact sheet | Press release |This report presents the latest findings of a major collaborative study aimed at measuring the prevalence of anti-tuberculosis drug resistance throughout the world. Drawing on data collected from 19972000, the report covers the second phase of a global project organized by WHO, the International Union Against Tuberculosis and Lung Disease (IUATLD), and other partners. The project was launched in 1994 in response to growing concern about the problem of drug-resistance and its potentially dramatic impact on the epidemiology and control of TB.
Apart from documenting the true magnitude of the problem, the project aims to ensure that policy recommendations for national TB control are backed by accurate and representative data. Particular attention is given to the role of WHO recommendations, which advocate the use of short-course chemotherapy and directly-observed treatment, in preventing the emergence of resistant strains of Mycobacterium tuberculosis or containing their spread. The project's first report was issued in 1997.
This second report represents both a considerable expansion in the number of geographical settings covered and a continuing refinement of the rigorous methodology used to collect data, verify their quality, and ensure correct interpretation. The report also marks the first opportunity to evaluate global trends in drug resistance over time. As of December 1999, 72 geographical settings had been surveyed to assess the magnitude of drug resistance and monitor trends.
Trends in resistance to any drug are covered together with trends in the prevalence of multidrug-resistant tuberculosis (MDR-TB), which is defined as resistance to at least isoniazid and rifampicin. The report also marks the first attempt to measure the impact of migration on the distribution of drug-resistant TB within a given country.
The report has four chapters. The first introduces the global project, and considers some of the factors associated with the emergence of drug-resistant M. tuberculosis in a population. Chapter two, on methods, explains how the vital need for accurate susceptibility testing is being met through the project's rigorous methodology, which relies on an international system of proficiency testing backed by a unique network of supranational reference laboratories.
Key findings are presented in the third chapter, which draws on data collected from 58 geographical settings. Results are presented separately for drug resistance among new cases, drug resistance among previously treated cases, and combined drug resistance. For the first time, trends over time are also presented and discussed.
While the study found drug-resistant TB in all settings, the magnitude of the problem varied widely across regions. MDR-TB among new cases was found to be most severe in Estonia, Latvia, the oblasts of Ivanovo and Tomsk in Russia, Henan Province in China, and Iran. Other areas of concern include Zhejiang Province in China, Tamil Nadu State in India, and Mozambique.
While data indicate that importation of drug-resistant M. tuberculosis into low-incidence countries is a substantial problem, most of the imported strains are not multidrug-resistant. Data further suggest that HIV infection is not an independent risk factor for either drug resistance or MDR-TB.
The final and most extensive chapter discusses findings in terms of their policy implications for national TB control. A critical review of the magnitude of drug-resistant TB on each continent includes abundant advice on the significance of trends and the corresponding priorities for control at both national and global levels. The chapter also considers how migration from countries with different levels of drug resistance can affect control programmes, and explores the complex factors that contribute to the emergence or spread of drug resistance.
Recommendations underscore the importance of good TB control programmes as the most reliable way to contain and decrease resistance. On the positive side, data collected during the study show that MDR-TB has not increased to a significant degree in geographical settings implementing sound TB control. Moreover, several settings with good control programmes have seen significant decreases in the prevalence of any drug resistance among previously treated cases.
Anti-tuberculosis Drug Resistance in the World
The WHO/IUATLD Global Project on Anti-tuberculosis Drug Resistance Surveillance
1997, 227 pages [E]
Sw.fr. 25.-/US $22.50; in developing countries: Sw.fr. 17.50
Order no. 1930117
Click here to view this book online
Describes the design and findings of a major study conducted to measure the prevalence of anti-tuberculosis drug resistance throughout the world. Jointly organized by WHO and the International Union Against Tuberculosis and Lung Disease (IUATLD), the study was initiated in response to growing concern about the problem of drug-resistance and its potentially dramatic impact on the epidemiology and control of TB. Apart from documenting the true magnitude of the problem, the study aimed to determine the impact of specific treatment policies on the level of drug resistance and thus provide lessons for effective TB control.
The study used a rigorous methodology and innovative quality control to achieve uniformly high-quality data unprecedented in their accuracy and international comparability. Thirty-five countries from five continents took part in the study, and surveys were conducted on over 50,000 tuberculosis cases sampled from areas representing 20% of the world's population
The book has four chapters. The first introduces the problem of drug resistance and discusses the many human errors, largely related to control programmes, that contribute to its development and spread. Chapter two, on methods, describes the great care taken to obtain reliable results and ensure that the prevalence of drug resistance would not be overestimated.
The results, which provide the first standardized overview of the level of drug resistance in the world, are presented in the third and most extensive chapter. Findings on the prevalence of resistance to standard anti-tuberculosis drugs are presented in a series of tables and maps showing the levels of primary, acquired, and combined resistance and multidrug resistance in the countries studied. The validity of these findings is underscored by data confirming the accuracy and reproducibility of drug susceptibility testing in the different laboratories concerned. Data correlating specific treatment policies with the magnitude of resistance are also presented.
Results are discussed in the final chapter, which reaches a number of key conclusions. Drug resistant strains were detected in all 35 countries, with the highest levels recorded for isoniazid, supporting the conclusion that drug resistance is ubiquitous. As a higher prevalence of multidrug resistant TB was found in countries categorized by WHO as having poor control programmes, the report further concludes that continued failure to improve TB control will fuel the spread of multidrug resistance. Country-wide standardization of anti-tuberculosis regimens, together with adequate drug supply and health care infrastructure, was associated with protection against the development of drug resistance in both developing and industrialized settings. The study also identified seven "hot spots" where the prevalence of multidrug resistant TB is high and prompt intervention is urgently needed. The report concludes with profiles of key data for each of the 35 countries included in the study. Presented according to a common framework, these profiles facilitate analysis and comparison of the wealth of data collected in this unprecedented study.
Anti-tuberculosis Drug Resistance in the World: Slide Set
1997, 60 colour slides
Sw.fr. 130.-/US $117.00; in developing countries: Sw.fr. 91.-
Order no. 1930127
A set of 60 colour slides produced as a companion to the report. Intended for use in teaching and training, the slides illustrate principles, methods and laboratory techniques used in the surveillance of drug-resistant TB, and communicate the project's main findings and conclusions.
Groups at Risk
WHO Report on the Tuberculosis Epidemic 1996
1996, 28 pages [E, F, P*, S*]
Sw.fr. 6.-/US $5.40; in developing countries: Sw.fr. 4.20
Order no. 1930084
Click here to view this report online
An alarming report on the global tuberculosis epidemic issued at a time when more people died from TB than in any other year in history. Analytical as well as descriptive, the report uses the latest WHO statistics to profile the groups at greatest risk, chart future trends, and explore the reasons why - with a powerful and inexpensive cure available - TB continues to spread so dramatically. Readers are reminded that TB is now the leading killer of youth and adults, that TB killed nearly three million people in 1995, and that an estimated 90 million people will become sick with TB in the next ten years. The rapid spread of multidrug-resistant TB raises the even more alarming prospect that TB may become incurable.
Against this background, the report examines trends in the groups at greatest risk: women, children, refugees, and HIV-infected individuals. As the report notes, TB kills more women than all causes of maternal mortality combined; it is the principal cause of death in HIV-infected individuals; and it may now infect almost half of the world's refugees. Since TB is widespread and contagious, the report also considers its impact on other "groups at risk": the workforce, travellers, the wealthy, and, indeed, the world at large. For all these groups, and in all situations, one clear conclusion emerges: use of DOTS (directly observed treatment, short-course) is not only the most cost-effective strategy, but the only one with a solid chance of halting the epidemic. Armed with these arguments, the report concludes with an urgent call for a "breakthrough" by people of power, influence, and compassion, who will see that this strategy is put to use effectively - for the sake of a world where everyone is at risk.
Guidelines for Conducting a Review of a National Tuberculosis Programme
J. Kumaresan, F. Luelmo, and I. Smith
1998, 70 pages (available in English)
Sw.fr. 12./US $10.80; in developing countries: Sw.fr. 8.40
Order no. 1930148
This book provides a comprehensive guide to the steps to follow when conducting a review of a national tuberculosis programme and collecting the data needed to monitor progress, identify problems, and plan solutions. Addressed to the managers of national tuberculosis programmes, the book places firm emphasis on the DOTS (directly observed treatment, short course) strategy and the need for close monitoring of its implementation as the best strategy for ensuring that all patients with tuberculosis are correctly diagnosed and treated until cured. Details range from a suggested day-by-day agenda for conducting the review, through lists of questions to ask during field visits and interviews with doctors and patients, to practical advice on ways to present conclusions to non-medical decision-makers and the press. Although information is specific to tuberculosis, the concepts and procedures set out in the guide can be used in other diease programmes as well.
Recommended procedures draw on experiences gained during more than a dozen in-depth programme reviews conducted in Africa, Asia, and Latin America in close collaboration with WHO. Throughout the guide, numerous checklists, model forms, and assessment tools are included to facilitate the collection and reporting of relevant, reliable, and standardized data.
The book has two parts. Chapters in the first introduce and explain each of the tasks required for planning and preparation, conducting the review, and following up on its conclusions and recommendations. Particular attention is given to the organization of field visits to observe the tuberculosis control system, to interview health workers and patients, and to collect quantitative data on programme performance. Abundant practical advice, firmly rooted in recent experiences, includes suggested timetables for completing each main group of tasks and alerts to potential problems.
The second part presents a large number of checklists, examples, and model forms designed to facilitate national reviews. A planning chart and suggested day-by-day agenda are followed by model forms for collecting and reporting data from the microscopy centre, on case finding, on two-month sputum conversion, and on treatment outcome. Also included are lists indicating the information that should be collected during interviews with doctors, laboratory staff, and patients, and recommended methods for determining the epidemiological situation of tuberculosis and defining the characteristics of the national control programme. Additional guidance includes recommendations for structuring reported findings, a checklist of what to investigate during a visit to a treatment centre, a methodology for economic analysis of TB control services, and advice on how to review staff training, define the programme's relationship with general health services, and communicate with the press.
Guidelines for the Management of Drug-Resistant Tuberculosis
J. Crofton, P. Chaulet and D. Maher
1997, 47 pages [E]
WHO/TB/96.210 Rev 1
Sw.fr. 15.-/US $13.50; in developing countries: Sw.fr. 10.50
Order no. 1930110
Click here to view these guidelines online
A guide to the management of patients who are resistant to one or more of the essential antituberculosis drugs. Intended for use within the context of well-managed national tuberculosis programmes, the book repeatedly stresses the need to prevent multi-drug resistant (MDR) tuberculosis in the first place, particularly as all second-line drugs are more expensive, less effective, and more toxic than first-line drugs. In view of these problems, the book strongly recommends that treatment of MDR tuberculosis be confined to specialized treatment units, regarded as a "luxury", and thus undertaken only in those countries with good to moderate resources for health care. Readers are further reminded that poor management of MDR tuberculosis increases the risk of incurable disease and thus does more harm than good.
Within the context of these recommendations and warnings, the book presents detailed guidelines for the specialized management of drug-resistant tuberculosis. Chapter one defines the various forms of drug-resistant tuberculosis and explains why its occurrence is always caused by human error. Chapter two describes the basic principles of management, giving particular attention to the functions of a specialized unit working in close collaboration with a well-equipped laboratory. Advice on the assessment of individual cases in provided in chapter three, which explains how to determine an appropriate treatment regimen.
To help clinicians select the most appropriate mix of drugs for individual patients, the fourth and most extensive chapter explains the place of available essential and second-line antituberculosis drugs in the management of MDR tuberculosis and ranks second-line drugs according to their biological activity, clinical criteria, and costs. Chapter five describes general principles to follow when selecting drug combinations for individual patients, and gives examples of acceptable regimens in programme conditions.
1998, 63 pages [E]
Sw.fr. 14./US $12.60; in developing countries: Sw.fr. 9.80
Order no. 1931167
A practical guide to the organization and management of laboratory services for tuberculosis control. Addressed to programme managers and administrators, the volume is the first in a series of three guides aimed at improving the quality of bacteriological services as an essential support for accurate diagnosis and reliable monitoring of treatment progress. Noting that laboratory services are often the most neglected component of national TB programmes, the guides promote the use of standardized techniques and procedures that are simple, reliable, and suitable for use in low- and middle-income countries.
The guide has eight chapters. The first introduces the importance of laboratory services to TB control and explains the appropriate roles of microscopy, culture, drug susceptibility testing and species identification. The organization of laboratory services is covered in chapter two, which outlines the most economical and efficient arrangements for laboratory services. Subsequent chapters offer advice on training, supervision, and motivation of laboratory staff and describe a number of standardized forms and procedures that can support efficient laboratory administration and record keeping.
Laboratory hygiene and safety are covered in chapter five, which offers detailed guidelines for the control of procedural hazards, laboratory hygiene, the safe use of disinfectants, essential safety equipment and supplies, and the management of accidents. Subsequent chapters describe recommended procedures for waste disposal and explain the vital role of well-designed and properly managed programmes for quality control. The final chapter offers advice on the health monitoring of laboratory workers. Further practical guidance is provided in a series of annexes, which reproduce a large number of model forms for reporting, registration, and evaluation.
Laboratory Services in Tuberculosis Control
Part II: Microscopy
1998, 61 pages [E]
Sw.fr. 16./US $14.40; in developing countries: 11.20
Order no. 1932167
An illustrated guide to microscopy as a simple, inexpensive, and reliable technique for the diagnosis of pulmonary tuberculosis and the monitoring of treatment progress and outcome. Addressed to programme managers and service administrators, the guide covers all the technical procedures and practical considerations needed for the efficient and accurate use of microscopy within the context of national control programmes. Particular attention is given to the use of standardized procedures that provide good results in low- and middle-income countries.
The guide, which can also be used for training, has ten concise chapters. The first provides a model plan for a peripheral microscopy laboratory, discusses the standard arrangement of equipment and materials, and outlines procedures for the care and maintenance of microscopes and balances. Subsequent chapters provide guidelines for the correct collection, storage, and transport of specimens and their safe handing during collection and smear preparation. An introduction to procedures for smear preparation is followed by an illustrated step-by-step guide to the do's and don'ts of acid-fast staining procedures, including both Ziehl-Neelsen and fluorochrome staining.
Smear examination procedures are covered in the next chapter, which introduces the components of the microscope, describes their correct use, and explains the systematic and standardized procedures needed to obtain excellence in microscopic examination. Particular emphasis is placed on common causes of errors and ways to avoid them. The remaining chapters cover the recording and reporting of results, and describe the components of a system for quality control in the microscopy laboratory.
1998, 95 pages [E]
Sw.fr. 22./US $19.80; in developing countries: Sw.fr. 15.40
Order no. 1933167
A practical guide to the many special techniques needed for the successful culture of specimens of Mycobacterium tuberculosis. Noting that bacteriological culture of tuberculosis is notoriously slow, difficult, and expensive, the guide concentrates on the exact procedures and precautions needed to prevent errors and ensure reliable results. Particular attention is given to techniques suitable for the financial and human resources of low- and middle-income countries.
The guide, which includes numerous illustrations and colour plates, has eleven chapters. The first introduces the role of bacteriological culture within the context of laboratory services for tuberculosis control, noting the unique contribution of culture to definitive diagnosis. Priorities for the effective use of culture are also identified. Chapter two sets out recommendations for the layout of a culture laboratory and equipment, and the logical flow of specimens and activities. Particular attention is given to ventilation and the correct use of biological safety cabinets as essential measures to protect staff from laboratory-acquired infections.
Subsequent chapters provide brief didactic advice on specimen collection, storage, transport and handling. Techniques for homogenization and decontamination are covered in chapter six, which provides highly detailed step-by-step instructions for various options suitable for countries with different resource levels. Chapter seven, on culture media, provides equally detailed instructions for preparing culture medium, emphasizing the advantages and disadvantages of different media, and the exact procedures that must be followed to achieve a successful culture. Chapter eight gives a brief description of inoculation and incubation procedures.
The most extensive chapter provides an illustrated guide to procedures for culture examination, identification, and interpretation of results. The remaining chapters offer guidelines for the uniform recording and reporting of laboratory results, and discuss the components of a system for quality assurance.
Stop TB at the Source
WHO Report on the Tuberculosis Epidemic 1995
1995, 28 pages + 26 page insert [E]
Sw.fr. 10.-/US $9.00; in developing countries: Sw.fr. 7.-
Order no. 1930065
Click here to view this report online
A dramatic report on the tuberculosis epidemic in 1995 written to persuade both rich and poor nations that it is in their own best interests to cure infectious TB cases throughout the world. The report concentrates on the WHO strategy for curing TB patients, which uses directly-observed treatment, short-course, or "DOTS". DOTS is a system where health workers watch as each patient takes the correct medication. A review of experiences from Tanzania, New York City, and China demonstrates how it is possible to reverse the TB epidemic by following the WHO control strategy.
Sections in the report show how the proper use of the proper medicines could virtually eliminate TB as a public health threat, and explain why other strategies, such as chemoprophylaxis, ventilation systems, and ultraviolet lights, cannot significantly reduce TB infections, cases and deaths worldwide. While lessons from Tanzania, New York City, and China show the striking success of the DOTS strategy, facts and figures from other parts of the world support the alarming conclusion that the majority of the world's health care systems are doing a poor job of curing TB patients. According to WHO estimates cited in the report, fewer than 30 percent of all countries are beginning to follow the control policies recommended by WHO and the International Union Against Tuberculosis and Lung Disease. Subsequent sections explore the reasons why the TB epidemic is growing larger and more dangerous each year, and explain the components - and costs - of WHO's 10-year battle plan to fight TB and prevent at least 12 million deaths. The report concludes with an urgent call for action.
TB/HIV: A Clinical Manual
A.D. Harries and D. Maher, with contributions
from M.C. Raviglione, P. Chaulet, P.P. Nunn and E. van Praag
1996, 135 pages [E, F]
Sw.fr. 12.-/US $10.80; in developing countries: Sw.fr. 8.40
Order no. 1930088
Click here to view this manual online
A pocket-sized guide to the clinical management of tuberculosis, particularly in patients suffering from co-infection with HIV. Designed for use by busy clinicians, the manual aims to promote the best possible diagnosis and treatment in low-income countries where the prevalence of TB and HIV infection is high, case loads are heavy, and laboratory support may be limited. With these needs in mind, the manual combines the latest scientific knowledge about these diseases with authoritative advice based on extensive field experience in several of the hardest hit countries. Throughout, tables, flow charts, lists of do's and don'ts, and numerous practical tips are used to facilitate quick reference and correct decisions.
The manual has twelve concise chapters presented in a convenient spiral-bound format. Background information is provided in the first chapters, which summarize basic facts about TB, HIV, and HIV-related TB, and outline a framework for effective TB control. Diagnosis is covered in four chapters, which set out detailed principles and procedures for the diagnosis of TB in adults and in children, and for the diagnosis of HIV infection in adults and in children with TB. Chapter seven presents standardized TB case definitions, by site of disease, result of sputum smear, and by previous treatment, and explains how these case definitions allow categorization of patients for treatment purposes.
Extensive treatment guidelines are presented in chapters devoted to the treatment of TB patients, management of the side effects of specific anti-TB drugs, and the management of other HIV-related diseases in TB patients. The manual concludes with a discussion of the importance of coordinated care in different settings, followed by advice on the prevention of TB in HIV-infected individuals.
"... excellent ... didactic without being
dogmatic ... Doctors practising medicine throughout the world can benefit from this lucid
account ... will be of great assistance..."
Transactions of the Royal Society of Tropical Medicine and Hygiene
Treatment of Tuberculosis
Guidelines for National Programmes
D. Maher, P. Chaulet, S. Spinaci, and A. Harries
1997, 77 pages [E]
WHO/TB/97.220 Rev 1
Sw.fr. 12.-/US $10.80; in developing countries: Sw.fr. 8.40
Order no. 1930109
Click here to view these guidelines online
Provides expert practical guidelines for the treatment and control of tuberculosis within the context of national TB programmes. Now in its second edition, the manual has been revised to reflect considerable experience, since 1993, in the use of WHO recommended control strategies. These advocate standardized short-course chemotherapy regimens, applied under proper case management conditions, and make the identification and cure of smear-positive pulmonary TB the first priority of any national programme.
With the effectiveness of these strategies now firmly established, the manual gives programme managers, policy-makers, and clinicians a clear - and proven - approach to TB control that relies on precise case definitions, distinct treatment categories, and standardized treatment regimens using essential anti-TB drugs. Since 95% of the global TB burden occurs in low- and middle-income countries, issues of cost-effectiveness are also repeatedly addressed.
The manual has eight concise chapters. Background information is provided in the first, which presents basic facts about the global TB epidemic and explains how control can be achieved through universal application of the WHO recommended DOTS (directly-observed treatment, short course) strategy. Further details about the DOTS strategy are presented in chapter two, which elaborates a framework for TB control and describes the components, targets, and policies of effective national programmes.
Against this background, the main part of the manual provides a didactic guide to the diagnosis and clinical management of cases. Chapter three, on case definitions, explains how to diagnose TB, define the type of case, and then match the case definition to one of four treatment categories. Standardized treatment regimens are covered in the next chapter, which describes the essential anti-TB drugs, presents the rationale for standardized treatment regimens, and discusses recommended and alternative regimens for each of the four treatment categories. Treatment regimens in special situations, such as pregnancy, lactation, and liver or renal disorders, are also described.
Chapter five explains how to monitor and record the response to treatment, especially in sputum smear-positive TB patients, and how to monitor and manage drug-induced toxicity. The vital importance of treatment adherence is addressed in chapter six, which includes practical examples of ways to ensure direct observation of treatment under different local circumstances. The remaining chapters offer guidance for the treatment of HIV-infected TB patients and explain what the managers of national programmes can do to ensure both the regular supply of essential drugs and their appropriate use. The important issues of drug quality and the bioavailability of fixed-dose drug combinations are also considered.
A practical guide to the full range of activities from epidemiological surveillance and political commitment to case management and the procurement of drugs needed to control tuberculosis. Addressed to the administrators and managers of control programmes, the handbook stresses the use of simple and largely standardized procedures developed by WHO during years of experience in low- and middle-income countries. Recommendations and advice cover all technical and practical issues relevant to effective control and good programme management.
Although staff involved in TB control are the main audience, the handbook should also prove useful to managers of refugee camps, prisons, and large private enterprises such as factories and mines, where TB prevalence can be very high.
The handbook has 23 chapters presented in nine parts. Chapters in the first part discuss the challenges posed by TB and present compelling arguments for a response that relies on cost-effective interventions of proven efficacy. Part two explains how to collect and analyze the data needed to assess the overall quality and coverage of a control programme and pinpoint weaknesses.
Against this background, the third and most extensive part provides a step-by-step guide to the practical and technical components of a revised TB control strategy. Numerous tables, checklists, sample calculations and model reporting and recording forms are used to illustrate the components of a standardized approach. Details range from advice on when to collect sputum specimens, through a tabular presentation of case definitions by site and bacteriological status, to guidelines for the selection of national demonstration and training districts.
Part four, on laboratory services, covers basic laboratory functions and equipment needs, and discusses the training and supervision of laboratory technicians. Supplies and logistics are covered in part five, which offers abundant practical advice on how to estimate drug requirements and procure high-quality drugs and other supplies in adequate quantities at reasonable prices. Chapters in the remaining parts cover training, communication, and advocacy; supervision , monitoring, and evaluation; budgeting; and the coordination of TB control activities with other disease programmes and governmental or external agencies.
Use DOTS More Widely
WHO Report on the Tuberculosis Epidemic 1997
1997, 52 pages + 20 page insert [Ar, E]
Sw.fr. 15.-/US $13.50; in developing countries: Sw.fr. 10.50
Order no. 1930103
Click here to view this report online
A report on the global tuberculosis situation in 1997. For the first time, this annual WHO report conveys a message of cautious optimism: recent evidence demonstrates the power of the DOTS (directly observed treatment, short-course) strategy, strongly advocated by WHO, to defeat TB in poor and wealthy countries alike. Noting that no other TB strategy comes close to being as effective and as affordable as DOTS, the report cites compelling evidence that wider use of DOTS could prevent up to 50 million deaths from tuberculosis in the next few decades.
The opening sections explain the five essential elements of the DOTS strategy, and present ten arguments for its wider use. These include cure rates as high as 95%, prevention of multidrug-resistant TB, and striking cost-effectiveness. Against this background, the main part of the report profiles the TB situation in each of the thirteen countries which are home to nearly 75% of the world's TB cases. For each country, particular attention is given to the extent to which the DOTS strategy has been adopted and the corresponding impact on TB rates. Experiences range from the crisis in Russia, where TB rates are climbing towards levels seen twenty years ago, to the remarkable success story of China, where DOTS treatment has been expanded to reach nearly 600 million people, and cure rates of 93% have been achieved. While firmly underscoring the power of DOTS to reverse the TB epidemic, these country experiences also identify a number of formidable obstacles.
The remaining sections explain what needs to be done to encourage countries to adopt DOTS in the light of this compelling evidence of its effectiveness. The report concludes with tables giving country-specific data on the number of estimated and reported TB cases and the number of cases being treated with DOTS.