March 28, 2015
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WHO outlines 'End TB Strategy'

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In an article recently published in The Lancet, WHO researchers outlined and detailed the organization’s new strategy to achieve worldwide eradication of tuberculosis.

The “Global strategy and targets for tuberculosis prevention, care and control after 2015,” or the End TB strategy, was first approved May 19. Numerous stakeholders, including ministries of health, scientific institutions, financial partners, health activists, non-government organizations and national tuberculosis programs, supported the plan’s 2 year development, which has the final goal of worldwide TB elimination by 2035.

“The strategy has a vision of making the world free of tuberculosis, with zero deaths, disease and suffering due to the disease,” Mukund Uplekar, MD, of WHO’s Global TB Programme, and colleagues wrote.
Four major barriers to this goal — weak health systems, poor social factors, a lack of diagnostic methods, regimens and vaccines, and insufficient funds — were confronted in the article.

“The new strategy aims to address these barriers by eliciting a strong, systemic response to end the tuberculosis epidemic drawing on the opportunities of the post-2015 development agenda, especially those related to achievement of universal health coverage and social protection,” they wrote.

The authors break down their approach into three spheres:

  • “integrated, patient-centered care and prevention,” which emphasizes early detection and modernized treatment while satisfying the educational, emotional and material needs of individuals;
  • “bold policies and supportive systems,” which require the involvement of multiple sectors to manage and prevent TB among people with HIV, migrants, refugees, prisoners, slum-dwellers and other vulnerable populations; and
  • “intensified research and innovation,” which entails operational research for the development of novel approaches and social research that is able to avert stigma and discrimination.

“The extent of tuberculosis burden in a society is a good indicator of gaps in health and social development,” Uplekar and colleagues wrote. “Therefore, ending of the tuberculosis epidemic is an important health and development goal, achievable in the foreseeable future and measureable too.”

Government officials are called upon to provide stewardship, create alliances with civil society organizations and communities, promote and protect human rights and to participate in the global partnership by adapting the strategy within their country.

“National adaptation of the global strategy based on in-depth analysis of the characteristics of the local tuberculosis epidemics and health systems will be as crucial as committing to international collaboration in view of increased travel and migration and threat to health security,” they wrote.

In wealthier countries, TB cases were reduced by 90% and TB-related deaths by 95% in 2013. Uplekar and colleagues noted that these reductions came after the development of rapid molecular tests and novel drugs, as well as policies that expanded health care access and addressed multiple forms of TB, including HIV-associated and drug-resistant TB.

Despite these gains, 9 million people developed TB and 1.5 million people died from the disease, according to the authors.

“The rich countries achieved remarkable reductions in the tuberculosis burden not only by delivering adequate tuberculosis services, but also by pursuing universal access to health care and social protections while rapidly improving nutrition and economic conditions,” they wrote. “Ending the tuberculosis epidemic in high-incidence countries needs a similar approach that guarantees access to high-quality tuberculosis care and prevention to all while simultaneously addressing the social determinants of tuberculosis.”