3. Tuberculosis control
Jim Yong Kim, Aaron Shakow, Arachu Castro, Chris Vande, Paul Farmer
Producing TB control: Obstacles
- Political, financial, managerial, infrastructural, and clinical challenges of TB control
- Different opinions on priorities and timing within the overall Global Plan
- Inadequate global coordination
Yet, obstacles to achieving global TB elimination are enormous:
- Political, financial, managerial, infrastructural, and clinical challenges of TB control. TB treatment requires 6 months contact with health services, the first 2 directly observed. In regions where drug resistance is a problem, short course regimens are not effective and longer, more expensive and difficult, regimens are required. In high HIV-prevalence regions, prophylactic therapy for latent TB infection, enhanced diagnostic capabilities, and coordination with HIV programs will be required to bring TB under control.
- While there is consensus on the Global Plan, there are different opinions on priorities and timing within the overall plan. At present, there is no consensus on how priorities are redefined in the context of new funding opportunities like the GFATM for example.
- Inadequate global coordination. Despite enormous efforts by TB-focused NGOs and the WHO, woefully inadequate funding has led to equally inadequate systems for both information gathering and dissemination. Lessons from the Global Polio Eradication Initiative (GPEI) could be very helpful for TB control. TB control has not had "champions" at the level and scale of the GPEI, and TB has never had the financial, administrative and political support of a large group like Rotary International. Similarly, the importance of global surveillance of MDR-TB should be a high priority.