Si l'incidence de la tuberculose continue a baisser dans les pays industrialises, il n'en est pas de meme dans les pays a faibles revenus et particulierement en Afrique subsaharienne ou le sida, l'urbanisation rapide et la pauvrete entrainent une explosion du nombre de cas declares.Pour maitriser cette maladie, de tres importants efforts ont ete realises ces dernieres annees et la strategie recommandee au niveau international, connue sous le nom de DOTS (pour Directly Observed Treatment Short-course), est promue dans differents pays. Son extension est neanmoins insuffisamment rapide et, si dans l'ensemble la prise en charge des malades s'ameliore, selon l'OMS le taux de detection, reflet de l'offre de soins et de l'accessibilite des patients aux services de sante, reste tres faible, autour de 40 %.L'arsenal therapeutique est limite et le developpement des resistances aux antituberculeux est un souci constant dans les programmes de lutte ; une surveillance de cette resistance est mise en place.Le regain d'interet pour la lutte contre la tuberculose est nouveau, et des mecanismes financiers ont ete tout recemment crees au niveau international, tels que le Global Drug Facility et le Fonds mondial contre le sida, la tuberculose et le paludisme. Si ces outils puissants sont bien utilises, ils devraient participer efficacement a la maitrise de l'epidemie.
Although the incidence of tuberculosis is continuing to fall in industrialised countries, this is not true for low-income and particularly sub-Saharan African countries, where AIDS, rapid urbanisation and poverty have led to an explosion in the number of notified cases.Enormous efforts have gone into tuberculosis control in the last few years, and the internationally recommended strategy known as DOTS (Directly Observed Treatment Short-course) is widely promoted. Nevertheless its implementation is not expanding rapidly enough, and although overall management of patients is improving, according to the WHO the detection rate, which reflects the availability and the accessibility of the health services for patients, remains very low, at around 40%.The number of drugs available for the treatment of tuberculosis is limited, and development of anti-tuberculosis drug resistance is a constant problem in the national tuberculosis programmes; a system of resistance surveillance has been put into place.There has recently been a renewal of interest in tuberculosis control, with the creation of two international financial mechanisms, the Global Drug Facility and the Global Fund for AIDS, Tuberculosis and Malaria. If these powerful tools are used well, they should make an effective contribution to the control of the epidemic.