General Introduction

Tuberculosis (TB) is a principal cause of mortality and morbidity among the adult population of low income countries. The Commission on Macroeconomics and Health (CMH) reports that TB contributes substantially to the avoidable mortality of the world’s poorest. The World Health Organisation (WHO) recommended strategy for TB control is known as DOTS (Directly Observed Treatment, short-course). 1 DOTS is based upon the premise that the early detection and effective treatment of TB cases reduces both the current burden of TB and the spread of the disease. This strategy has been proven to be highly effective and cost-effective in low income settings (1). However, today DOTS is only available to around half the world’s population and thus there remains a considerable mountain to climb to ensure global access to effective TB treatment. In March 2000, governments from around the world formalised the accelerated expansion of DOTS in the Amsterdam Declaration to Stop TB. The Global Stop TB partnership 2 has built on this commitment and developed a plan of action, the Global Plan for TB Control. This was further updated to the Global Plan II for 2006-2015, in line with the Millennium Development Goals. A central aim of the plan is to ensure that by 2015 70% of notified TB cases globally will have access to DOTS.