BACKGROUND: The World Health Organization (WHO) recommends a package of services branded 'DOTS' (directly observed treatment, short course) to help countries detect at least 70% of all infectious tuberculosis (TB) cases and cure 85% of detected cases. We analyzed the epidemiology of TB and the national TB program (NTP) performance for the first 5 years of DOTS implementation in Thailand. METHODS: We reviewed data routinely collected through the NTP from 2001 to 2005 and data from special projects conducted by the NTP from 2001 to 2006. RESULTS: In 2005, the TB notification rate was 94 per 100,000 persons. Using the WHO estimated incidence as the denominator, the case detection rate was 76% for smear-positive cases in 2005. From 2002 to 2005, the notification rate declined 2% for smear-positive cases. In 2005, 68% of smear-positive patients were successfully treated; from 2001 to 2005, treatment success never exceeded 75%. Separate surveys conducted from 2002 to 2006 found that 13-17% of TB cases were HIV-infected. The estimated prevalence of multidrug-resistant TB in new patients increased from 1% in 2002 to 1.7% in 2006. CONCLUSIONS: Since DOTS implementation, Thailand has exceeded the international TB case detection target, but has remained well below the treatment success target. The large discrepancy between case finding and treatment success rates indicates that actions are urgently needed to reduce TB morbidity and prevent drug-resistant TB.
BACKGROUND: The World Health Organization (WHO) recommends a package of services branded 'DOTS' (directly observed treatment, short course) to help countries detect at least 70% of all infectious tuberculosis (TB) cases and cure 85% of detected cases. We analyzed the epidemiology of TB and the national TB program (NTP) performance for the first 5 years of DOTS implementation in Thailand. METHODS: We reviewed data routinely collected through the NTP from 2001 to 2005 and data from special projects conducted by the NTP from 2001 to 2006. RESULTS: In 2005, the TB notification rate was 94 per 100,000 persons. Using the WHO estimated incidence as the denominator, the case detection rate was 76% for smear-positive cases in 2005. From 2002 to 2005, the notification rate declined 2% for smear-positive cases. In 2005, 68% of smear-positive patients were successfully treated; from 2001 to 2005, treatment success never exceeded 75%. Separate surveys conducted from 2002 to 2006 found that 13-17% of TB cases were HIV-infected. The estimated prevalence of multidrug-resistant TB in new patients increased from 1% in 2002 to 1.7% in 2006. CONCLUSIONS: Since DOTS implementation, Thailand has exceeded the international TB case detection target, but has remained well below the treatment success target. The large discrepancy between case finding and treatment success rates indicates that actions are urgently needed to reduce TB morbidity and prevent drug-resistant TB.