The dynamics of tuberculosis in response to 10 years of intensive control effort in Peru

Improved tuberculosis (TB) case detection and cure rates are expected to ac celerate the decline in incidence of TB and to reduce TB-associated deaths. Time series analyses of case reports in Peru showed that the per capita TB incidence rate was probably steady before 1991. Case reports increased bet ween 1990 and 1992 as a result of improved case detection. Although diagnos tic efforts have continued to increase since 1993, the incidence of new pul monary TB cases has declined in every department of the country, with a nat ional rate of decline greater than or equal to5.8% per year (range, 1.9%-9. 7%). This elevated rate of decline suggests that 27% (19%-34%) of cases (15 8,000) and 70% (63%-77%) of deaths (91,000) among smear-positive patients w ere averted between 1991 and 2000. This is the first demonstration that a s ignificant number of TB cases can be prevented through intensive short-cour se chemotherapy in a high-burden country.