How to hinder tuberculosis control: five easy steps.

The control of tuberculosis remains an area of interest and concern. Some recent Lancet papers bring positive news, albeit with important questions left unanswered. Wang and colleagues' longitudinal study1 concluded that tuberculosis prevalence in China was reduced by shifting to the recommended approach based on directly observed treatment, short course (DOTS) for tuberculosis diagnosis and treatment, but did not consider that economic progress might have also been a driver. Pietersen and coworkers' cohort study,2 which reported that 73% of patients with extensively drug-resistant tuberculosis in South Africa died within 5 years of treatment initiation, acknowledged the poor treatment outcomes but did not question whether survival is any better than in the pre-treatment era—better than no treatment at all.3 A review by Dheda and colleagues4 aptly highlighted that diverting funding to multidrug-resistant tuberculosis control might destabilise national tuberculosis programmes, using the example of South Africa where multidrug-resistant tuberculosis represents less than 3% of tuberculosis cases but consumes over a third of the national tuberculosis budget.