Towards TB elimination in low-incidence countries
TB treatment and care
Global elimination of TB as a public health problem, defined as <1 TB case per million population, is a long-term vision of WHO’s End TB Strategy, while the time-bound global target is to “End the global TB epidemic”, defined as bringing down the global incidence from >1,000 per million population in 2015 to <100 per million by 2035.
Adaptation of targets and interventions to national and local TB epidemiology and health system context is a key principle of the End TB Strategy. Special considerations are needed for “low-incidence countries” - countries that have already reached <100 TB cases per million. In those countries, the ambition must be to rapidly progress further to “pre-elimination” of TB, defined as <10 TB cases per million, and then to TB elimination.
WHO and partners have developed an action framework low-incidence countries striving to eliminate TB in coming decades (insert link to framework and fact sheet). This framework lists the following eight priority action areas to guide national policy makers in low-incidence countries:
- Ensure political commitment, funding and stewardship for planning and essential services
- Address the most vulnerable and hard-to-reach groups
- Address special needs of migrants and cross-border issues
- Undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment
- Optimize the prevention and care of drug-resistant TB
- Ensure continued surveillance, programme monitoring and evaluation and case-based data management
- Invest in research and new tools
- Support global TB prevention, care and control.
The following three TB risk groups should be systematically screening for active TB:
Screening in other selected risk groups can be considered after a careful assessment of epidemiological relevance, health system preparedness, and risks and benefits for the individual, please refer to the WHO guideline on systematic screening for active tuberculosis:
- Lönnroth K, Corbett E, Golub J, Godfrey-Faussett P, Uplekar M, Weil D, Raviglione M. Systematic screening for active tuberculosis: justification, definitions and key considerations. Int J Tuberc Lung Dis 2013; 17: 289–298.
- Kranzer K, Afnan-Holmes H, Tomlin K, Golub JE, Shapiro A, Schaap A, Corbett L, Lönnroth K, Glynn JR. A systematic literature review of the benefits to communities and individuals of screening for active tuberculosis disease. Int J Tuberc Lung Dis 2013; 17: 432–446.
- Uplekar M, Cresswell J, Ottmani S, Weil D, Lönnroth K. Programmatic approaches to screening for active tuberculosis Int J Tuberc Lung Dis 2013; 17: 1248–1256