Advances in the management of tuberculosis: clinical trials and beyond.

Modern short-course treatment for tuberculosis is highly effective and cost-effective, yet the disease remains a leading cause of suffering and death. The problem has been exacerbated in recent years by the human immunodeficiency virus (HIV) pandemic and the increasing prevalence of multidrug-resistant tuberculosis. Improvements in diagnosis, vaccination, chemoprophylaxis, and therapy are thus urgently needed. Molecular techniques are facilitating the development of rapid and sensitive diagnostic tests and the rational approach to the production of new vaccines. New forms of treatment are being investigated and there is also considerable emphasis on optimizing the deployment of the available treatment regimens. This has resulted in the World Health Organization's five-point directly observed therapy, short course (DOTS) strategy and proposed modifications (DOTS-plus) for the management of multidrug-resistant (MDR) tuberculosis. Despite these advances, it is becoming abundantly clear that the failure to control tuberculosis is a direct consequence of the gross inequities in the distribution of wealth and health care provision worldwide, which do not allow for putting advances in the management of tuberculosis into practice. The control of tuberculosis will therefore require attention to justice and human rights as well as greatly increased technical and financial support from the developed nations.