Currently, at global level, the TB notification rate is still growing at an average 1% per year, largely the result of the constant increase of cases in sub-Saharan Africa and, to a lesser extent, in the former USSR.While the worsening of the TB incidence in Africa is due to the HIV epidemic compounded by a weak health infrastructure, in Eastern Europe it is due to different causes, including economic decline and increased poverty, social disruption, and substandard health services. In addition, new biological properties of Mycobacterium tuberculosis, in particular the high ability to develop resistance to anti-tuberculosis drugs and wide dissemination of virulent strains of the W-Beijing genotype, have also contributed to TB epidemic in the region.13 As a result of these factors, more than 10% of new TB cases in the Baltic states and in some parts of Russia are multidrug-resistant (MDR)- TB, i.e. resistant to isoniazid and rifampicin.

In the European region 445,000 new TB cases and nearly 70,000 deaths were estimated to have occurred in 2004. In the Eastern part of the region the levels of Directly Observed Treatment, Short Course (DOTS) coverage and case detection are the lowest among the world regions, and the overall treatment success rate is the second lowest (75%) after Africa. In Western countries, cases mostly involve elderly and immune suppressed subjects and immigrants,but also the young generations are exposed to the risk of being infected. Unfortunately, the disease is perceived as disease of the past and very few resources, human and financial, are mobilized at the European level.

Toward the Development of a Strategy of TB Control
Based on Styblo’s studies in Tanzania in the 1980s (the pilot project of the International Union Against Tuberculosis and Lung Diseases (IUATLD, currently called UNION)), it was estimated that diagnosing at least 70% of infectious TB cases and curing 85% of them would allow to reduce TB transmission in the community of about 40%, and lower TB incidence with a time span of five to seven years.The 70% case detection rate and the 85% cure rate were taken by the World Health Assembly as the targets for TB control. In the 1990s,WHO developed a strategy of TB control to reach these targets, which is universally known as DOTS.This acronym was initially used to define two key elements of this strategy, the administration of a standardised shortcourse treatment regimen under direct observation.

Tuberculosis control is a public health function consisting of rapid diagnosis and effective treatment of infectious cases, in addition to preventive interventions, monitoring, and surveillance. Treatment can rapidly render infectious cases (e.g. sputum smear-positive cases) non-infectious, breaking the chain of transmission.