Dynamics and control of the global tuberculosis epidemic

Studies of disease burden have reaffirmed that tuberculosis is among the top 10 causes of death in the world. The tuberculosis epidemic in most countries could eventually be brought under control by implementing the World Health Organization's (WHO) directly observed therapy, short course (DOTS) strategy, although tuberculosis linked to human immunodeficiency virus (HIV) in Africa and multidrug-resistant tuberculosis (MDR-TB) in the former Soviet Union urgently demand adaptations and extensions of DOTS. Most high-incidence countries have achieved treatment success rates approaching the WHO 85% target in pilot projects. In the long term, we may have better diagnostics, drugs, and vaccines to control the disease; for the next 5 years, the central problem in global tuberculosis control is to expand DOTS coverage in high-incidence countries. Improved case finding and diagnosis, coupled with best-practice short-course chemotherapy, could quickly and dramatically cut the number of years of healthy life lost due to tuberculosis, especially by preventing death.