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Progress towards tuberculosis elimination in Cuba.

SETTING
The Cuban National Tuberculosis Control Programme (NTCP) was implemented in 1962, and has included directly observed treatment since 1971 and DOTS since 1982.


OBJECTIVE
To assess the short-term trends of major indicators of tuberculosis (TB) elimination.


METHODS
A surveillance system has been created on treatment and case finding. Data from the National TB Registry of the Ministry of Public Health were reviewed.


RESULTS
The incidence of TB declined from 1965 to 1991 from 65.0 to 4.7 per 100000 population, then reversed in the period 1992-1994. The implementation of a re-intervention package recovered the increase from 1995 to 1998. From 1999 to 2003, 97.5% of TB suspects identified underwent sputum smear microscopy. The incidence rate declined from 10.0 to 7.2/100000. In 2003 the case detection rate was 92.2%; the overall TB cure rate was 92% and TB human immunodeficiency virus (HIV) co-infection was 3%. Two of Cuba's 15 provinces reached incidence rates of <5/100000, eliminating TB as a public health problem.


CONCLUSION
Low incidence, high detection and cure rates, along with low rates of TB-HIV co-infection, are evidence of progress towards the elimination of TB as a public health problem in Cuba, using DOTS in a context of good socio-cultural and technological interaction.