END OF TB

END OF TB

The World Health Organization (WHO) has presented new guidelines as part of its Post-2015 Global Tuberculosis Strategy (End TB). This document outlines a 20-year blueprint and now addresses the management of latent tuberculosis. The new guidelines promote for the first time the screening of specific vulnerable populations for latent TB infection and treating the infection to prevent progression to active TB disease, which currently kills 1.5 million people a year. The guidelines recommend programmatic intervention for more than 100 countries with an incidence below 100 cases per 100,000. An estimated nine million people worldwide had active TB disease in 2013 and 1.5 million died of the disease, according to the WHO. While treatment efforts in the past two decades have reduced the death toll from the ongoing TB epidemic, the disease is still taking lives in all regions of the world. The WHO is putting forward a broad strategy to end the global epidemic by 2035, reduce TB deaths by 95%, cut active cases by 90%, and eliminate the catastrophic economic burdens in TB-affected regions. The strategy outlines actions to strengthen TB treatment and prevention; mobilize resources; accelerate development of new drugs, vaccines, and diagnostics; and reform social support.

For the first time, the WHO calls on health authorities to confront the problem of latent TB infection (LTBI)—a global pool of two billion people infected with Mycobacterium tuberculosis, who stand up to a 10% chance of developing active, contagious TB disease. The WHO recommends screening the most at-risk populations, such as HIV-positive patients, young children, people in contact with active TB patients, and immunocompromised patients, and providing preventive treatment to those considered at risk of active TB development. The strategy also calls for more study of preventive treatment in a range of high-risk groups

VISION	A world free of tuberculosis – zero deaths, disease and suffering due to tuberculosis
GOAL	End the global tuberculosis epidemic
MILESTONES FOR 2025	– 75% reduction in tuberculosis deaths (compared with 2015); – 50% reduction in tuberculosis incidence rate (compared with 2015) (less than 55 tuberculosis cases per 100 000 population) – No affected families facing catastrophic costs due to tuberculosis
TARGETS FOR 2035	– 95% reduction in tuberculosis deaths (compared with 2015) – 90% reduction in tuberculosis incidence rate (compared with 2015) (less than 10 tuberculosis cases per 100 000 population) – No affected families facing catastrophic costs due to tuberculosis
PRINCIPLES
1. Government stewardship and accountability, with monitoring and evaluation 2. Strong coalition with civil society organizations and communities 3. Protection and promotion of human rights, ethics and equity 4. Adaptation of the strategy and targets at country level, with global collaboration
PILLARS AND COMPONENTS
1. INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION A. Early diagnosis of tuberculosis including universal drug-susceptibility testing, and systematic screening of contacts and high-risk groups B. Treatment of all people with tuberculosis including drug-resistant tuberculosis, and patient support C. Collaborative tuberculosis/HIV activities, and management of co-morbidities D. Preventive treatment of persons at high risk, and vaccination against tuberculosis
2. BOLD POLICIES AND SUPPORTIVE SYSTEMS A. Political commitment with adequate resources for tuberculosis care and prevention B. Engagement of communities, civil society organizations, and public and private care providers C. Universal health coverage policy, and regulatory frameworks for case notification, vital registration, quality and rational use of medicines, and infection control D. Social protection, poverty alleviation and actions on other determinants of tuberculosis
3. INTENSIFIED RESEARCH AND INNOVATION A. Discovery, development and rapid uptake of new tools, interventions and strategies B. Research to optimize implementation and impact, and promote innovations