Running out of Breath - TB Care in the 21st Century

This paper takes a critical look at current TB control efforts: programme strategy (DOTS), diagnostic tools and treatments, as well as research and development (R&D) needs. It hopes to spark debate about how people suffering from TB can best be helped, and especially what role MSF can play on the medical, operational and political levels. Recommendations are made in Section 6.

Like other organizations and health care providers involved in treating people with tuberculosis (TB), MSF has first-hand experience of the current WHO recommended strategy to control TB, DOTS (Directly Observed Treatment Short-Course). While most MSF and other experts agree that DOTS is the 'best approach we have', DOTS has demonstrated serious limitations in its nearly decade-long existence Ð particularly since the HIV/AIDS pandemic has completely transformed the landscape of TB care.

In the past three years, MSF has been delivering antiretroviral (ARV) treatment to individuals in need in even the most resource-poor settings by adapting treatment protocols and counselling and monitoring methods accordingly. The HIV/TB co-infection has magnified the limitations of DOTS and is changing MSF's thinking on how care provided to people living with TB might be improved.