[The results of DOTS strategy]

Tuberculosis control in Japan is now on the stage of program transition since the declaration of emergency of tuberculosis in 1999. The "21st century DOTS, Japan version" has been proposed under the influence of DOTS experiences in the United States, where drastic reduction of tuberculosis was observed after the introduction of universal DOT. We cannot copy the experiences of US, considering the difference of epidemiological situation of tuberculosis, social background of TB cases and the difference of health infrastructure for TB patients. In the United States, many tuberculosis patients are treated under government health system with DOT. In Japan, TB cases are treated at clinics and hospitals under the integrated health system and public health centers mainly provide prevention services including contact examination of TB and cohort analysis of TB cases. 21st century DOTS, Japan version, is not the universal system at present but it is on the process of implementation and various kind of new activities have been tried including activities to assure the close collaboration between public health centers and clinics, and DOT activities including hospital based DOT, ambulatory intermittent DOT at pharmacies. Here are presented with various experiences both in the field of collaboration between public health centers and clinics, and in the field of DOT. Also here are presented with the calculation which shows the reduction of total cost of tuberculosis treatment by the introduction of ambulatory DOT, considering the influence of recurrence of defaulter cases which would have occurred without DOT. We consider that this symposium is the interim report of the expansion of Japanese DOTS.