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.