SETTING: Israel has implemented a new tuberculosis (TB) control programme in response to the rise in the incidence of tuberculosis due to immigration in the last decade. It complies with World Health Organization guidelines, and also includes specific measures addressing the needs of immigrants. We describe the new programme and compare the outcome of treatment prior and after its realisation. METHODS: Each component of the new strategy was scrutinised, aspects that did not function well were identified and how we contended with these issues is described. Analysis of outcome of treatment was according to WHO/IUATLD definitions. RESULTS: Better and clearer organisation of TB treatment in all its aspects, including cultural sensitivity, has been obtained. Compliance improved from less than 27% for successful outcome before the new programme to more than 75% after. In addition to the improvement in completion rates, the universal use of directly observed treatment has ensured enhanced adherence. CONCLUSION: Using legislative, administrative and budgetary measures, as well as clinical guidelines published by the Ministry of Health, the TB infrastructure in Israel has been successfully reorganised. The decision to do so was not only clinically and organisationally justifiable, it is also economically viable.

DOTS Tuberculosis epidemiology Treatment policy Israel Immigration

law Israel Human immunodeficiency virus infection public health service health care policy capreomycin human immigration comorbidity economic aspect priority journal BCG vaccine nonhuman health program Humans tuberculostatic agent Antitubercular Agents budget Treatment Outcome Tuberculosis, Pulmonary preschool child tuberculosis Infant communicable disease control cultural factor health maintenance organization cycloserine Incidence Article streptomycin patient compliance major clinical study adult isoniazid Practice Guidelines data analysis antibiotic sensitivity politics tuberculosis control world health organization Emigration and Immigration ethambutol Health Policy Cultural Characteristics ethionamide rifampicin decision making treatment planning pyrazinamide practice guideline