Bulletin of the World Health Organization

Financial resources required for tuberculosis control to achieve global targets set for 2015

Katherine Floyd, Andrea Pantoja

Volume 86, Number 7, July 2008, 568-576

Table 1. The five major interventions of the Global Plan to Stop TB, 2006–2015

Intervention categories Componentof Stop TBStrategy/ Partnership Working Group Description Costs included Definition ofunit cost Baseline (2005)level of intervention coverage and scale-upanticipated by 2015 Main sources ofcost data
DOTS expansion Component 1Component 3Component 4Component 5.1Working Group: DOTS Expansion Case-finding and treatment according to the DOTS strategy as implemented up to 2005, plus much more emphasis on four newer approaches to TB control: PPM; PAL;a community TB care; and diagnosis based on culture and DST as well as sputum smear microscopy First-line drugs, NTP staff, NTP management and supervision activities, training, NTP buildings and vehicles, laboratory equipment and supplies for smears, cultures and DST, consultants, X-rays for diagnosis of smear-negative TB, days in hospital and outpatient visits to health facilities during treatment Cost per patient treated, except for PPM start-up and organizational costs, community TB care, PAL and laboratory inputs required for culture and DST, for which costs were estimated per 500 000 population Case detection rate of 60% globally in 2005. By 2015, case detection rate 84% globally (range 80% in Africa to 98% in Eastern Europe),b with total of 50 million patients treated under DOTS 2006–2015. Increased case detection facilitated by large increase in percentage of population living in areas where PPM and PALa are implemented (10–100% and 20–60% respectively, range reflects variation among regions), and increase in availability of community TB care (to cover all of Africa and 20–30% population in other regions), all versus low/negligible coverage in 2005 WHO Global Financial Monitoring Project (complete data for around 90 countries with 90% global cases), disease control priorities in developing countries project (DCPP), WHO-CHOICE database, PPM costing studies

MDR-TB and XDR-TB diagnosis and treatment Component 2Working Group: MDR-TB Treatment of patients with MDR-TB and XDR-TB using first- and second-line drugs according to WHO guidelines Second-line drugs, hospitalization, outpatient visits, incentives and enablers, management of side-effects, training, laboratory tests, programme/data management Cost per patient treated Negligible number of patients with MDR-TB treated according to WHO guidelines before 2006 (cumulative total about 10 000). By 2010, 100% of diagnosed cases of MDR-TB and XDR-TB treated according to WHO guidelines. Number of patients treated: 1.6 million over 10 years Published costing studies from Estonia, Peru, the Philippines, and the Russian Federation

Collaborative TB/HIV activities Component 2Working Group: TB/HIV Activities recommended by WHO, which fall into three categories:(1) mechanisms for collaboration between TB and HIV programmes (four activities);(2) activities to reduce burden of HIV in TB patients – HIV testing and counselling, HIV prevention services, ART, CPT, HIV care and support (five activities);(3) activities to reduce burden of TB in people living with HIV – IPT, infection control, intensified TB case finding (three activities) Coordinating bodies at different administrative levels, staff to coordinate TB and HIV programme activities, six months of ART and six months of CPT for eligible TB patients, HIV tests and counsellors, clinical staff and questionnaires for screening of TB, palliative care and treatment of opportunistic infections, six months of IPT for those eligible Cost per patient treated (ART, CPT, HIV care and support).Cost per person tested (HIV testing and counselling, HIV prevention services).Cost per person treated (IPT) Negligible or limited coverage in 2005. Universal access to ART by 2010, with other activities scaled-up accordingly. Total of 3 million HIV+ TB patients enrolled on ART 2006–2015 UNAIDS and WHO-CHOICE (ART, other HIV care and support, HIV prevention); costing of projects in Malawi, South Africa and Zambia, for all other activities

ACSM Component 5Working Group: ACSM Activities aimed at placing TB high on the political agenda, improving knowledge about TB among general public, mobilizing communities Mass media campaigns, press conferences, training, information, education and communication, community outreach, promotion of patients’ charter Cost per 500 000 population covered Negligible or limited coverage in 2005. All countries implementing ACSM activities countrywide by 2015 Global Fund Round 5 proposals for five countries

Technical assistance All components and working groups Assistance provided in NTPs by staff from international agencies with expertise in TB control Staff and activities such as country missions, workshops, guideline development Cost per region Staff and activities approximately doubled from baseline (2005) levels DOTS Expansion Working Group secretariat

ACSM, advocacy, communication and social mobilization; ART, antiretroviral treatment; CHOICE, CHOosing Interventions that are Cost-Effective; CPT, co-trimoxazole preventive therapy; DOTS, a strategy for TB control; DST, drug susceptibility testing; IPT, isoniazid preventive therapy; MDR-TB, multidrug-resistant tuberculosis; NTP, national tuberculosis programme; PAL, Practical Approach to Lung Health; PPM, public–public and public–private mix; TB, tuberculosis; UNAIDS, the Joint United Nations Programme on HIV/AIDS; XDR-TB, extensively drug-resistant tuberculosis.a PAL (Practical Approach to Lung Health) is designed to improve the management of patients with respiratory symptoms by training general health care workers, nurses, doctors and managers working in primary health care settings.b Epidemiological regions are given in reference 6.

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