摘要：In response to the global challenge of inadequate case detection of tuberculosis (TB), the Fund for Innovative DOTS Expansion through Local Initiatives to Stop Tuberculosis (FIDELIS) was developed in 2003 to rapidly assess and implement innovative approaches to increase the detection of new smear-positive TB cases. As previously reported, a wide range of target populations and interventions has been incorporated into successful FIDELIS projects. KEY FINDINGS A wide range of community-based activities to increase awareness of TB was implemented rapidly on a wide scale. FIDELIS support provided an opportunity to consider innovative approaches that might not otherwise have been attempted. Increases in the detection of new smear-positive cases in FIDELIS sites compared with the previous year and compared with non-FIDELIS sites may be partly the result of the intensive community-based activities. Further evaluation of each specific approach will be needed to assist TB control partners in prioritizing approaches to a broad scale-up in the TB control effort. ONE PROJECT OF THE FUND for Innovative DOTS Expansion through Local Initiatives to Stop Tuberculosis (FIDELIS) in Bangladesh implemented by a nongovernmental organization, BRAC (formerly the Bangladesh Rural Advancement Committee), introduced a comprehensive set of community-based activities to increase awareness of tuberculosis (TB) and the steps necessary to be properly diagnosed and treated for the disease. One year of project activities covered 10 districts and a population of 27.56 million. A total of 21718 new smear-positive cases were detected during the 12 months of project activities—5756 more than the previous year. An estimated 8.8 million people became ill with TB and 1.6 million people died from this disease in 2005. 1 A failure of countries to reach global case-detection targets remains one of the greatest barriers to achieving global TB control. In the early 2000s, several initiatives were introduced to address the global case-finding challenge. FIDELIS is a US$31-million fund launched in April 2003 to increase case detection of new smear-positive cases of TB while maintaining high cure rates within the Directly Observed Therapy Short Course strategy. 2 Funding for FIDELIS came from the Canadian International Development Agency, and the project is managed by the International Union against Tuberculosis and Lung Disease (the Union). As part of the FIDELIS initiative, locally designed approaches to increase TB case detection are rapidly implemented and evaluated.
