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Target Market Profile 111

overworked. Public outcry, including spontaneous street demonstrations by TB
patients calling for access to effective drugs, led to high-level commitment and
action. The country’s incoming government declared TB a significant and wide-
spread public health problem and allocated additional resources to their
National Tuberculosis Control Program (NTCP), increasing the annual budget
from US$600,000 to US$5 million (Llanos-Zavalaga et al., 2004; WHO, 2008c).
The country clearly not only recognized the impact the disease was having on its
citizens, but also on the country’s economy. With TB affecting primarily the
most economically productive age group, and a 1999 study showing the eco-
nomic cost of TB between US$67 and US$108 million, most considered this sig-
nificant increase a “good investment”(Llanos-Zavalaga et al., 2004).
The purpose of this bolstered effort of course was to decrease the incidence of
TB, with two areas of focus. One was on Directly Observed Treatment—Short
Course (DOTS), an internationally recommended approach for TB control pro-
grams where a trained healthcare worker monitors the patient taking each dose of
anti-tuberculosis medication. The treatment comprises initial daily doses, followed
by twice-weekly doses, directly observed to ensure compliance. Without this focus
and service, many patients were not completing their regime or taking medications
in a timely manner, leading to prolonged illnesses and increased infections in com-
munities. (Although DOTS is the focus of global tuberculosis control, this short
course therapy does not cure MDR-TB. In settings of high transmission of multi-
drug-resistant tuberculosis, “DOTS-plus,” a complementary DOTS-based strategy
with provisions for treating multi-drug-resistant tuberculosis, is recommended.)
The second important area of focus was on the identification of patients currently
infected so that treatment could begin.

TA RG E T M A RKE T P ROF I L E

Getting more people identified who are currently infected and then getting those
diagnosed to accept and complete recommended drug therapies required a plan
working with key markets downstream, midstream, and upstream. The strategies
used are discussed later, but here, first, are the target markets for the plan.
Downstream efforts for diagnosis were to focus on reaching high-risk
groups, especially the urban poor in crowded, urban areas known as “TB pock-
ets” or “hot spots.” The capital city of Lima was one such target, with 60% of all
cases in the country, but only 29% of the population (Llanos-Zavalaga et al.,
2004). As noted earlier, TB mainly affects the most economically productive age
group, those between 15 and 54 years of age (Llanos-Zavalaga et al., 2004).
“Closed populations,” because of their high TB prevalence, were also a priority