[EQ] Tuberculosis control and elimination 2010-50: cure, care, and social development

Tuberculosis control and elimination 2010—50: cure, care, and social development

Dr Knut Lönnroth PhD a , Kenneth G Castro MD b, Jeremiah Muhwa Chakaya MD c, Lakhbir Singh Chauhan MD d, Katherine Floyd PhD a, Philippe Glaziou MD a, Mario C Raviglione MD a

The Lancet, Volume 375, Issue 9728, Pages 1814 - 1829, 22 May 2010

Website: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60483-7/fulltext

“…..Rapid expansion of the standardised approach to tuberculosis diagnosis and treatment that is recommended by WHO allowed more than 36 million people to be cured between 1995 and 2008, averting up to 6 million deaths. Yet tuberculosis remains a severe global public health threat.

 

There are more than 9 million new cases every year worldwide, and the incidence rate is falling at less than 1% per year. Although the overall target related to the Millennium Development Goals of halting and beginning to reverse the epidemic might have already been reached in 2004, the more important long-term elimination target set for 2050 will not be met with present strategies and instruments. Several key challenges persist. Many vulnerable people do not have access to affordable services of sufficient quality.

 

Technologies for diagnosis, treatment, and prevention are old and inadequate. Multidrug-resistant tuberculosis is a serious threat in many settings. HIV/AIDS continues to fuel the tuberculosis epidemic, especially in Africa. Furthermore, other risk factors and underlying social determinants help to maintain tuberculosis in the community.

 

 Acceleration of the decline towards elimination of this disease will need invigorated actions in four broad areas: continued scale-up of early diagnosis and proper treatment for all forms of tuberculosis in line with the Stop TB Strategy; development and enforcement of bold health-system policies; establishment of links with the broader development agenda; and promotion and intensification of research towards innovations….”

 

This article is part of The Lancet Series on tuberculosis, which was developed and coordinated by Alimuddin Zumla (University College London Medical School, London, UK); Mario C Raviglione (Stop TB Department, WHO, Geneva, Switzerland); and Ben Marais (University of Stellenbosch, Stellenbosch, South Africa).

Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis

Dr Neel R Gandhi MD a b , Paul Nunn FRCP c, Keertan Dheda PhD d e, Prof H Simon Schaaf MD f, Matteo Zignol MD c, Dick van Soolingen PhD g, Paul Jensen PhD h, Jaime Bayona MD i
The Lancet, Volume 375, Issue 9728, Pages 1830 - 1843, 22 May 2010
URL: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60410-2/fulltext

 “….…..Although progress has been made to reduce global incidence of drug-susceptible tuberculosis, the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis during the past decade threatens to undermine these advances. However, countries are responding far too slowly.
Of the estimated 440 000 cases of MDR tuberculosis that occurred in 2008, only 7% were identified and reported to WHO. Of these cases, only a fifth was treated according to WHO standards.

Although treatment of MDR and XDR tuberculosis is possible with currently available diagnostic techniques and drugs, the treatment course is substantially more costly and laborious than for drug-susceptible tuberculosis, with higher rates of treatment failure and mortality. Nonetheless, a few countries provide examples of how existing technologies can be used to reverse the epidemic of MDR tuberculosis within a decade.

 

Major improvements in laboratory capacity, infection control, performance of tuberculosis control programmes, and treatment regimens for both drug-susceptible and drug-resistant disease will be needed, together with a massive scale-up in diagnosis and treatment of MDR and XDR tuberculosis to prevent drug-resistant strains from becoming the dominant form of tuberculosis. New diagnostic tests and drugs are likely to become available during the next few years and should accelerate control of MDR and XDR tuberculosis.

 

Equally important, especially in the highest-burden countries of India, China, and Russia, will be a commitment to tuberculosis control including improvements in national policies and health systems that remove financial barriers to treatment, encourage rational drug use, and create the infrastructure necessary to manage MDR tuberculosis on a national scale.

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