The Lancet: Experts set out targets to eliminate tuberculosis within a generation
2019 MAR 28 (NewsRx) -- By a
Published ahead of World TB Day (
“This report is optimistic about ending TB - a disease that is preventable, treatable and curable However, there is no room for complacency in our work, and we must act quickly and strategically to save the next generation from TB,” says lead Commissioner Dr
TB remains the leading infectious killer of our time, responsible for 1.6 million deaths worldwide in 2017, with drug-resistant forms of TB threatening control efforts in many parts of the world. In addition, in 2017, around a quarter of the world’s population were living with TB infection.
The
Scaling up existing interventions and reaching high risk groups
The first priority for most high burden countries is to ensure that high quality diagnostic tests and treatments are available for all people with active TB.
Many people with TB, especially the poorest, cannot access or afford services, and health systems are often slow to identify and investigate cases, meaning patients do not complete treatment or recover. Currently more than a third of TB cases (35%) are not diagnosed or treated. The authors call for universal access to drug susceptibility testing [2] at diagnosis to ensure that all patients are given appropriate treatment, including access to second-line treatment for drug-resistant TB. Estimates for this report suggest that increasing these interventions (drug susceptibility testing to 90% of people diagnosed, and second-line treatment to 85% of people with drug-resistant TB) in
However, private health care is often the main route to diagnosis and treatment for patients in high-burden countries, meaning countries and donors must engage with the sector to improve care. Modelling demonstrates that subsidising tests and supporting patients to complete treatment in
Identifying groups at high risk of TB infection (including people with HIV, people living in the same house as someone with TB, migrants, prisoners, health care professionals, and miners) and bringing them into care will be vital, including offering TB prevention, such as treating latent TB. This is particularly important in people with HIV, where risk of co-infection is high and TB is the leading cause of death. By making TB prevention available to 90% of people with HIV in
Once high-risk populations and those already in care have access to affordable, high quality services, introducing universal health coverage is needed to help countries find remaining TB cases.
Investing in TB
However, even if current treatments were extended to 90% of people with TB, and 90% were successfully cured, existing efforts would have failed to avert 800,000 deaths in 2017. Global research investment needs to increase by up to four times (from
Affected countries, donor nations, private sector, and philanthropies must also devise effective financing strategies to end the TB epidemic. The initial global costs to reduce TB deaths by 90% (from 1.7 million per year to less than 200,000 a year) could be in the order of
Investing in TB has a strong return on investment, with an estimated
More public finances must be allocated to TB (from increasing GDP levels, taxing tobacco and alcohol, and by increasing health insurance) in addition to increased investment in local expertise and infrastructure. Estimates suggest that
Global donors also need to invest more wisely. Currently, only 24% of global health aid goes to global functions (compared with country-specific functions) that could help multiple countries, such as research and development, negotiating for lower prices for TB drugs, and leadership and advocacy. This funding should be extended to include a focus on reducing drug-resistant TB to avoid cross-border spread, and ensuring high risk groups are identified and cared for potentially through social insurance schemes.
“While there are many challenges to ending TB, we have the potential right now to address this problem. We have rapid, sensitive diagnostic tools, and the promise of potent TB treatment strategies in the pipeline. In addition, TB control strategies, new health technologies, sustained global economic growth, increased commitment to achieve universal health coverage, and growing political momentum could all make ending TB within a generation more feasible than ever before. With sound science, political will, shared responsibility, TB is a solvable problem.” says report co-author Dr
Speaking about the report’s role in
Accountability: A shared responsibility for TB
Increased accountability for TB at the local, national and global level is needed. Heads of government must be held accountable for their TB outcomes and report these biannually at the
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