Progress in Global Tuberculosis Control 199597

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TB Care for All Evolution of the DOTS Strategy
Dr Mario RaviglioneDirector, STB/WHO Beijing,
China 14-15 October 2004
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Aims of this presentation

• To set the main direction for acceleration of TB
  control
• To outline the need for a care approach in TB,
  besides a public health one
• To present the vision for an enhanced 2004 DOTS

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Global TB Control Targets

• WHA (year 2005) - To detect 70 of infectious TB
  cases
• - To treat successfully 85 of detected
  cases
• Okinawa - G8 50 reduction in prevalence and
  deaths by 2010
• MDGs To have halted and begun to reverse
  the incidence of TB by 2015.

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Progress towards targets
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Progress towards Global Targets70/85 by 2005

• Case detection rate 43
• Treatment success rate 82
• Best forecast
• treatment success achieved
• case detection close, but not achieved

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Main directions to accelerate DOTS expansion and
adapt to reach all

• Keep expanding and sustaining DOTS achievements,
  supporting countries to build capacity and to
  mobilise resources, within strengthened health
  systems
• Advocate for (1) DOTS, as the recognised public
  health strategy for TB control, and (2) the
  importance of individual patient care within DOTS
• Engage all care providers, public and private, to
  increase access and use of a universal standard
  of care, especially among the poorest
• Promote community participation and mobilise
  societies to increase (1) demand for proper care
  and (2) involvement in care
• Adapt DOTS to high HIV and MDR-TB settings, and
  strengthen capacity to diagnose and manage
  SS(neg) TB and drug resistant cases
• Strengthen ME for problem-solving and to measure
  achievements vis-à-vis WHA MDG targets
• Sustain the Stop TB Partnership and its Working
  Groups

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Quality TB care for all Ensure a high standard

• Patient care to cure and prevent TB is the
  ultimate goal of DOTS
• The foundation of DOTS is effective patient care
  which alleviates suffering, as well as controls
  and prevents TB in a community
• A standard of care for TB exists already, and is
  evidence-based, but needs further promotion among
  all care providers
• Simply, each care provider, public or private,
  should
• 1- Diagnose TB quickly (i.e., bacteriological
  confirmation)
• 2- Treat TB properly (i.e., SCC and treatment
  support)
• 3- Report TB cases and treatment outcomes
• If all providers did the right thing, we would
  control TB

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Enhanced DOTS Strategy

• Government commitment with long-term planning
  andsustainable financing to reach WHA and MDG
  targets
• Diagnosis through bacteriology (microscopy and
  culture)
• Standardized treatment under proper case
  management conditions, including DOT, and full
  patient support for all
• An effective drug supply system and laboratory
  network
• An adequate recording and reporting of cases and
  outcomes
• To do this properly, in 2004, we also need to
  explicitly.
• Engage all care providers, public and private, in
  the delivery of a high standard of TB care for
  all cases, infectious first and non-infectious
• Partner with communities
• Include TB/HIV interventions and DOTS for MDR-TB
  into national country TB control strategies

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Standard of care and expanded DOTS strategy
proposed next steps

• TBCTA-funded project to further document strong
  evidence-base for standard of care (led by ATS,
  with WHO and other partners)
• Expanded DOTS policy document outlining
• Chronology of DOTS evolutionary process
• Revision of 5 elements
• Explicit reference to the issues of standard of
  care by all providers and mainstreaming of TB/HIV
  and DOTS-Plus into comprehensive TB control plans
• Communication strategy for new policy document in
  line with WHA resolution and evidence-base
  standard of care (supply and demand sides)

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Input from STB-CB

• Is this an appropriate and effective approach?
• How do we build ownership in this process?

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