Principles of IUATLD collaborative tuberculosis progammes.

The success of IUATLD-assisted National Tuberculosis Programme developed by Dr. Karel Styblo is dependent on a number of important principles. The most important step is the organization of the basic components of the National Tuberculosis Programme. This first step requires 1) a political commitment on the part of the Government, 2) a secure supply of drugs and materials, including a reserve stock, 3) a network of microscopy centres with a system of quality control and 4) proper recording and reporting of cases. These conditions can result in significant improvement in case-finding and treatment results but rarely results in a cure rate of smear-positive cases in excess of 55 per cent. To obtain the levels of cure necessary to achieve an epidemiologic impact, it is necessary to employ short-course chemotherapy. Additional conditions must be met for this to be successful: 1) adequate supervision of drug-taking in the initial intensive phase, 2) proper training of staff prior to commencement of the treatment and 3) step-wise introduction throughout the country. Several factors may adversely affect the outcome of treatment programmes. These are drug resistance, a high rate of relapse and HIV infection. To date, the IUATLD-assisted programmes have shown sustained success.