Is the global tuberculosis control strategy too big to fail?

In 1996 WHO stated that “MDR-tuberculosis is too expensive to treat in poor countries; it detracts attention and resources from treating drug-susceptible cases”.3 Faith in directly observed treatment, short course (DOTS) slowly eroded, because leaving people with multidrug-resistant tuberculosis untreated was increasingly recognised as being both unethical and a bad tuberculosis control strategy. From 2003 to 2017, $43 billion were budgeted by international and domestic sources for control of tuberculosis and HIV-associated tuberculosis (appendix).5 Resource allocation data are scarce, so past investments are difficult to match with their effect on service delivery and health. [...]serious doubts remain about the impact of investing millions of dollars to deploy the Xpert MTB/RIF assay to diagnose tuberculosis and multidrug-resistant tuberculosis in endemic countries.6 It is also very difficult to know with certainty what proportion of resources are being used to provide direct services to people with tuberculosis.