Is the DOTS strategy sufficient to achieve tuberculosis control in low- and middle-income countries? 1. Need for interventions in universities and medical schools.

Now that progress is gradually being made in the implementation of the DOTS strategy in low-income countries, we must take into account the fact that nearly 30% of all tuberculosis (TB) cases worldwide occur in middle-income countries, which usually have an adequate health infrastructure and sufficient economic resources for TB control. These countries nevertheless have other limitations that make it necessary to develop other aspects in addition to the DOTS strategy. These can be summarised in three main themes: 1) adequate coordination of all health structures involved in TB management, ensuring that they follow the basic norms of the National Tuberculosis Programme (NTP), 2) direct intervention in universities and medical schools, which are ubiquitous in such countries, and 3) specific collaboration with specialists and physicians in private practice, an important obstacle to the success of NTPs in several countries. A detailed analysis is presented of strategies that need to be implemented in different countries depending on their economic resources and their TB situation. The need to carry out specific interventions in addition to training in DOTS in universities and medical schools in order to improve TB control is discussed. A specific project in this area developed by the IUATLD in Latin America is described.