Encompassing treatment with prevention: the path for a lasting control of tuberculosis

Tuberculosis is an important cause of death, mainly in the less developed countries. Thus far the strategy for its control had relied on the diagnosis of sick individuals and provision of chemotherapy. However, this strategy is problematic for several reasons: poor education about the disease and the low income of people with tuberculosis are important barriers for them to have access to early diagnosis and to keep adherence to treatment; provision of 'preventive therapy' to the enormous pool of people infected with tuberculosis is not feasible in less developed countries; and finally, long-term political commitment with the strategy is unlikely. Several facts indicate that tuberculosis patterns in different populations are shaped by biological, behavioral and socio-economic factors. This paper argues that a lasting control of tuberculosis requires a strategy based on a broader model of causality, which takes account of all these three causal factors.