Trade, foreign policy, diplomacy and health

3. Tuberculosis control

Jim Yong Kim, Aaron Shakow, Arachu Castro, Chris Vande, Paul Farmer

TB control: DOTS (2)

  • Standardized nature of DOTS simplifies drug-supply considerations, allowing inexpensive and effective management
  • But, DOTS not being implemented quickly enough
  • Only 27% of people diagnosed with TB receive DOTS

The benefits of DOTS are clear. The standardized nature of DOTS has simplified drug-supply considerations, which allows for inexpensive and effective management even where health-care infrastructure is lacking. The cost of DOTS-based TB control is approximately $20-57 per death averted, and U.S.$ 1-3 per disability-adjusted life year (DALY) gained. Without treatment, an estimated 70% of people with infectious TB will die. Although weak TB-control can decrease mortality, they have less impact on morbidity, as many people remain chronically ill.

However, DOTS can rapidly reduce both mortality and morbidity from TB, often curing over 85% of patients. Since curing TB prevents the infection of others, it serves an important preventive function as well, breaking the chain of transmission. If DOTS has an Achilles' heel, it's that it is not being implemented quickly enough. Only 27 percent of people diagnosed with TB receive DOTS. Less than half of the world's population in 1999 had access to DOTS-based treatment-even in principle. In practice, only 23% of estimated new TB cases were reported to DOTS programs in 1999. At this rate, the WHO's goal of identifying 70% of TB cases worldwide through DOTS will not be realized until 2013.