Scale up: meeting targets in global tuberculosis control.

Despite great progress, global targets for tuberculosis case detection and cure might not be reached by 2005. In particular, there is a serious case-detection gap between estimated annual incident cases and those reported under the strategy for tuberculosis control branded as DOTS. Delays in reaching targets result in lack of effect on incidence of disease, which is of particular concern in regions where incidence is increasing-eg, sub-Saharan Africa and the former Soviet Union. Four key actions will speed up progress towards reaching global targets: 1) equipping national tuberculosis programmes to have a stewardship role in engaging all health providers in implementing the DOTS strategy; 2) establishing the feasibility of national certification systems of DOTS coverage; 3) promoting community action to contribute to patient care and to voice demand for the DOTS strategy; and 4) increasing support to sub-Saharan Africa for implementation of a strategy of expanded scope to counter HIV-1-fuelled tuberculosis.