J Epidemiol Community Health 58:822-825 doi:10.1136/jech.2003.008664
  • Evidence based public health policy and practice

To control and beyond: moving towards eliminating the global tuberculosis threat

  1. Timothy F Brewer1,
  2. S Jody Heymann2
  1. 1Department of Medicine, Mount Auburn Hospital, Brigham and Women’s Hospital and Harvard Medical School, USA
  2. 2Department of Society, Human Development and Health, Harvard School of Public Health, USA
  1. Correspondence to:
 Dr T Brewer
 Department of Medicine, Mount Auburn Hospital, 330 Mount Auburn Street, Cambridge, MA 02138, USA;
  • Accepted 26 January 2004


For 10 years the World Health Organisation has had a single answer to the deadly threat of tuberculosis (TB)—provide treatment to smear positive patients and watch them take it. In contrast with confident statements about how global TB would be brought under control when directly observed therapy, short course (DOTS) was introduced, TB continues to rise worldwide. The introduction of selected multiple drug resistant TB treatment programmes, “DOTS-Plus”, although important, also focuses on therapy for active TB. HIV endemic countries in particular have experienced tremendous increases in TB despite having DOTS programmes. A critical review of recent epidemiological data and computer models shows that the present international strategy of concentrating on providing treatment for smear positive TB, DOTS and DOTS-Plus, is likely to have only a modest impact on population based TB control. Effective global TB control will require strategies that go beyond relying on treatment of people with active disease.


  • Funding: this work was supported by a Clinical Investigator Award no 1K08 AI01444-01A1 from the National Institute of Allergy and Infectious Diseases.

  • Conflicts of interest: none declared.