Fully one third of the world's population is estimated to be infected with latent TB, which can become active when the immune system weakens. TB is the single largest killer of people with HIV/AIDS, and is a leading cause of death among women of reproductive age.

Active TB, primarily a disease of the respiratory system, is highly contagious and spread through the air. It can be cured through a 6-month course of directly observed treatment (DOTS). Common factors contributing to the growth of TB globally are inadequate health services, the emergence of multi-drug resistant TB (MDR-TB), and the HIV/AIDS epidemic.

The DOTS strategy, recommended by WHO, is internationally recognized as an effective tool to combat TB. The standard chemotherapy regimen with direct observation has been launched in many countries with the support of local governments. DOTS has proven highly effective in curing TB, preventing the emergence of drug resistant TB, and preventing new TB infections. Successful treatment rates of 85-95% are possible through effective DOTS programs — regardless of HIV status — and TB control is among the most cost-effective public health interventions.

The next challenge is to harness the power of local communities and the private sector to help governments address this growing global health problem. There is also a need to aggressively find, prevent, and treat TB among those living with HIV/AIDS.

In March 2004, PSI started implementing its first DOTS program through the Myanmar Sun Quality Health (SQH) network of franchised private general practitioners — as well as through government health clinics. PSI's SQH clinics provide high quality TB screening services and treatment products, at locations where vulnerable people already go for health care. PSI/Myanmar also uses social marketing to motivate people at risk to get tested and complete treatment under DOTS supervision. Program components include training SQH franchise members and technicians of participating labs in TB diagnosis and treatment, as well as branding DOTS services, drugs and communications to reduce stigma and increase awareness.

A similar program focusing on social marketing through franchised clinics for TB prevention and treatment is under development in Pakistan. PSI Kenya is creating a TB/HIV communications campaign to support government DOTS treatment centers. TB screening and prevention programs are also being designed using Isoniazid, a six-month drug that keeps latent TB from becoming active among those with HIV.

• PSI/Myanmar

• PSI/Pakistan

PSI/Myanmar's mass media promotion for DOTS features national superstar Yazar Ne Win and creates public demand for testing, treatment, and adherence. Watch the video