Major challenges for tuberculosis control are closely linked with access to health services, especially for the poorest and most vulnerable people.82 Poor access impedes early and full case detection, and leads to low treatment success in many African and eastern European countries. Bottlenecks in the health system interact to create varied delivery challenges in high-burden countries. The form of the health system, the evolution of service integration, and decentralisation policies are specific to countries, so a variety of service delivery models are used to address tuberculosis, MDR tuberculosis, and HIV-associated tuberculosis.