Building a tuberculosis-free world: The Lancet Commission on tuberculosis

Abstract

growing political momentum to definitively address tuberculosis, could all make ending the pandemic within a generation more feasible than ever before. Moving forward with bold, comprehensive strategies Globally, the priority must be to deliver person-centred and family-centred services to all individuals with tuberculosis who present to care. This approach means ensuring that high-quality diagnostics, treatment, and prevention modalities are available to all, wherever they seek care. Improving quality of tuberculosis care in the private sector is crucial to end tuberculosis in high incidence countries such as India, the country with the highest tuberculosis burden. Modelling shows that optimising private sector engagement in India could avert 8 million deaths from tuberculosis between 2019 and 2045 (appendix p 3). In high drug-resistant tuberculosis burden countries, access to rapid drug susceptibility testing (DST) and second-line drugs is essential to success. In Moldova, where more than 25% of all tuberculosis cases are drug-resistant, improving access to DST and second-line drugs would reduce mortality from drug-resistant tuberculosis by 44% in the coming generation (appendix p 3). Secondly, tuberculosis programme budgets must increase to enable reaching these people and populations at high risk of tuberculosis. In Kenya, for example, where the proportions of HIV and tuberculosis coinfection are high, scaling up access to both antiretroviral therapy and tuberculosis preventive therapy can help save an additional 3 million lives over the next generation (appendix p 3). However, ultimately, the fight against tuberculosis will not be won unless countries also ensure that everyone, not just high-risk groups, can access essential health Key messages The Commission recommends five priority investments to achieve a tuberculosis-free world within a generation. These investments are designed to fulfil the mandate of the UN High Level Meeting on tuberculosis. In addition, they answer the question of how countries with high-burden tuberculosis and their development partners should target their future investments to ensure that ending tuberculosis is achievable. Invest first to ensure that high quality rapid diagnostics and treatment are provided to all individuals receiving care for tuberculosis, wherever they seek care This priority includes rapid drug susceptibility testing and second-line treatment for resistant forms of tuberculosis. Achieving universal, high-quality person-centred and family-centred care-including sustained improvement in the performance of private sector providers-usually should be the top policy and budget priority. Reach people and populations at high risk for tuberculosis (such as household and other close contacts of people with tuberculosis, and people with HIV) and bring them into care Active case-finding and treatment in high-risk populations demands adequate resources to reach and care for these populations. At the same time, reaching certain high-risk populations, such as people co-infec...

New opportunities in tuberculosis prevention: implications for people living with HIV

“…In 2018, the UN High‐Level Meeting (UNHLM) on Tuberculosis galvanized the global efforts to prevent TB by setting renewed targets to provide TB preventive therapy (TPT) to 30 million people by 2020 including six million PLHIV . Following the UNHLM, a Lancet Commission on TB: “Building a tuberculosis‐free world” underscored the rollout of TPT among PLHIV as a cornerstone for achieving success in the global TB control efforts, complemented with active TB case‐finding and initiation of prompt and effective TB treatment . Evidence shows that TPT reduces TB incidence, and also mortality in PLHIV up to 37% independent of ART and is a cost‐effective intervention, even using shorter regimens .…”

“…Moreover modelling studies underpin expanded use of TPT as an essential intervention to reduce the global TB burden, with great effect in high HIV prevalence settings . Despite these facts, TPT scale‐up within HIV programmes has been appallingly low and insufficient to effectively decrease the TB burden in PLHIV . With an estimated 920,000 new TB infections among PLHIV and 300,000 deaths (a third of HIV‐related deaths globally in 2017), the UN target to reduce TB deaths among PLHIV by 75% by 2020 will remain unmet .…”

An overview of new antitubercular drugs, drug candidates, and their targets

“…Several reviews have been published recently that focus on the current regimens and emerging drugs to combat XDR‐TB, MDR‐TB, and HIV‐TB coinfected patients, major drug targets exploited and the role of emerging targets in TB drug discovery process while some articles analyze the effect of clinically approved antimycobacterial drugs on pathogens of the WHO priority pathogen list . Some other reviews focus on strategies to prevent the development of resistance and reduce transmission instead of finding their treatment and how to strategically invest to have a tuberculosis‐free world . A recent review discusses fragment‐based approach where fragments forming high‐quality interactions with target molecules are identified and used to generate more potent lead compounds …”

“…17-20 Some other reviews focus on strategies to prevent the development of resistance and reduce transmission instead of finding their treatment and how to strategically invest to have a tuberculosis-free world. 21,22 A recent review discusses fragment-based approach where fragments forming high-quality interactions with target molecules are identified and used to generate more potent lead compounds. 23…”

‘They are inconveniencing us’ - Exploring how gaps in patient education and patient centred approaches interfere with TB treatment adherence: Perspectives from patients and clinicians in the Free State Province, South Africa.

“…The WHO End TB Strategy has endorsed a holistic patient centred model of care, focused on patient rights and welfare, to improve TB outcomes globally (26)(27)(28). Disseminating accurate, evidence-based TB information among patients and clinicians alike, is fundamental to achieving this.…”