The point of view of a high prevalence country: Malawi.

The National Tuberculosis Programme switched to short-course chemotherapy for smear-positive cases when the IUATLD started to assist in 1984. Treatment results in smear-positive cases improved from a 50-55% cure rate to an 87% cure rate in new cases (and 89% in retreatment cases). The hope of reducing the tuberculosis problem was then challenged by the occurrence of HIV-related cases of tuberculosis which are now considerably over-stretching services. Smear-negative cases and extrapulmonary tuberculosis now represent almost two thirds of all patients. For them, standard chemotherapy has now been changed to 2 R3H3Z3/2 HE(or TH)/4H in order to try and save money on syringes, needles and water for injection as well as prevent transmission of HIV through injections. This regimen will also enable the programme to depart from hospitalization since patients will take medication on an ambulatory basis. It may also give more time to district tuberculosis officers for the supervision of health centers.