Tuberculosis (TB)

WHO report 2008
Global tuberculosis control

2.8 Summary

Implementation of the Stop TB Strategy varies among components and among countries. The first component and foundation of the strategy - DOTS – is the most widely implemented. It is also the component for which progress is closest to matching the expectations of the Global Plan. In 2006, 93% of the world’s population lived in areas where DOTS was being implemented, and the global case detection rate was 61%. The treatment success target of 85% had almost been reached by the end of 2005. At the same time, there is much scope for improvement in the provision of laboratory culture and DST services, and, while impact measurement is advanced in some regions, it is at an early stage of development in others.

Besides DOTS implementation, diagnosis and treatment of MDR-TB and collaborative TB/HIV activities (both under component 2) are the other major parts of the Stop TB Strategy for which implementation can be best quantified. Although implementation still lags behind the Global Plan, there is clear evidence of major progress in the implementation of interventions such as HIV testing for TB patients and provision of CPT and ART to HIV-positive TB patients in the African Region. There is also progress in the diagnosis and treatment of MDR-TB, but here current and projected levels of implementation are far behind the Global Plan in the South-East Asia and Western Pacific regions, and within these regions in China and India in particular.

Among components 3–6, our understanding of implementation is more limited, because to date it is less well quantified. In the area of health system strengthening (component 3), considerable work on HRD is needed in many countries in all regions, although reported alignment with broader health sector planning frameworks as well as expansion of PAL to a larger number of countries are encouraging.

PPM and the ISTC (component 4) are being introduced and expanded in an increasing number of countries. However, the relative contribution of different providers to detection, referral or treatment of cases will remain unclear until the new routine recording and reporting forms recommended by WHO are more widely introduced.

ACSM (component 5) is still a new area for many countries and one where much more guidance and technical support are necessary. For this report, information on operational research (part of component 6) was comparatively superficial.

Overall, planning and implementation that covers all elements of the Stop TB Strategy and that is in line with the targets set in the Global Plan is already happening in some countries, but now needs to extend to many more.