PHM-Exch> Tuberculosis control and elimination 2010-50: cure, care, and social development

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crossposted from EQUIDAD at listserv.paho.org


 *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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