Assessing the Impact of the Directly Observed Treatment Short-Course (DOTS) for the Control of Tuberculosis in DOTS-Recipient Countries: Cross-National Evidence for 1996-2006

Objective: To assess the impact of the World Health Organization (WHO) Directly Observed Treatment Short-Course (DOTS) TB control strategy for reducing the burden (i.e., incidence, prevalence and mortality rates) of TB infections in the last decade.;Research question: To what extent has the WHO's DOTS strategy for TB control influenced the growth and levels of TB in DOTS recipient countries in the last decade?;Method: Descriptive study using country-level aggregate data from the WHO global TB and the Human Development Index (HDI) United Nations Human Development Program (UNDP) databases for the period of 1985-2006.;Results: DOTS has influenced the growth and levels of TB burden in countries it was applied except in Africa. Differences in both disease burden levels and DOTS impact on TB control outcomes between DOTS and Non-DOTS recipient countries were significantly influenced by socio-economic conditions of individual countries. There is evidence that, to make the DOTS impact on TB control outcomes comparable in Africa to that of the rest of the world, health system strengthening is a key challenge to improving the delivery of effective, accessible and affordable TB care.;Conclusion: Overall, global TB prevalence fell, but incidence rose and mortality remained unchanged in the last decade. Although it was difficult to link the observed differences with DOTS, and TB burden levels, more TB cases were reported in DOTS-recipient than non-DOTS-recipient countries. While the DOTS strategy seemed effective in reducing TB burden levels in all other regions, significant differences were observed between Africa and the rest of the world.