BMJ 1998;317:671-674 ( 5 September )

Education and debate

Community based approaches to the control of multidrug resistant tuberculosis: introducing "DOTS-plus"

Paul Farmer, associate professor,  Jim Yong Kim, instructor. 

Department of Social Medicine, Harvard Medical School, 641 Huntington House, Boston, MA 02115, USA

pefarmer@bics.bwh.harvard.edu

The first 150 words of the full text of this article appear below.

Tuberculosis remains the world's leading infectious cause of adult deaths, most of which are due not to multidrug resistant tuberculosis but to lack of access to effective treatment for drug susceptible tuberculous disease.1 New data suggest, however, that multidrug resistant tuberculosis is emerging as an increasingly important cause of morbidity and death. In the United States, Europe, and Latin America, highly resistant strains of tuberculosis have caused explosive institutional outbreaks (in hospitals, prisons, and homeless shelters) with high case fatality rates among immunosuppressed people and high rates of transmission to other patients and to caregivers and their families.2-8

These outbreaks are not restricted to certain regions. The WHO/International Union Against Tuberculosis and Lung Disease's global survey of resistance to antituberculous drugs now reveals that multidrug resistant tuberculosis has already become established worldwide. In several countries---including Russia, Estonia, Latvia, Côte d'Ivoire, and the Dominican Republic---"hot zones" of ongoing transmission . . . [Full text of this article]
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Rapid Responses:

Read all Rapid Responses

"DOTS-plus" strategy hard to implement
Jaime E Ollé-Goig
bmj.com, 23 Sep 1998 [Full text]
Multidrug resistant TB in Western Siberia
N Banatvala
bmj.com, 7 Oct 1998 [Full text]
Big problems in Moldova
Nick Banatvala
bmj.com, 15 Oct 1998 [Full text]
The WHO treatment regimens need revision
S K Agarwal
bmj.com, 12 Jun 2000 [Full text]
Re: "DOTS-plus" strategy hard to implement
Fuad Mirzayev
bmj.com, 18 Feb 2004 [Full text]
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