Towards tuberculosis elimination: an action framework for low-incidence countries

Abstract

This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards “pre-elimination” (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions.

Understanding the incremental value of novel diagnostic tests for tuberculosis

“…1b). Alternatively, most transmission may occur from hardto-reach populations in which the rate for seeking care is low 52 . Each of these The 'standard' model.…”

Numbers needed to treat to prevent tuberculosis

“…We thank Martina Sester and colleagues for their careful reading of our paper [1] and for their support to the prospect of tuberculosis (TB) elimination in low-incidence countries in a foreseeable future. While we respect the views of the authors that the targets may appear too ambitious, we believe that, if the scientific community stay focussed on innovative approaches that can translate into scalable and effective interventions, we could reap the benefits of such interventions within the space of the next two decades [2].…”

Un schéma thérapeutique plus court qui s'annonce prometteur pour le traitement de l'infection tuberculeuse latente chez les Canadiens à risque

“…Un schéma thérapeutique plus court qui s'annonce prometteur pour le traitement de l'infection tuberculeuse latente chez les Canadiens à risque C Pease 1 , KR Amaratunga 2,3 , GG Alvarez 1,3,4 * Résumé Malgré les succès récents qui ont permis de réduire l'incidence de la tuberculose, cette maladie demeure un important problème au Canada, en particulier chez les personnes nées à l'étranger et les populations autochtones. Le traitement de l'infection tuberculeuse latente (ITL) est l'un des éléments clés de la stratégie visant à lutter contre cette maladie.…”