Tuberculosis targets – are we making progress fast enough?

The burden of tuberculosis (TB) is still very high, and progress that is not moving fast enough to reach targets, according to the WHO’s most recent global tuberculosis report, providing an insight into the ongoing burden of this disease.

The global tuberculosis report has been published every year since 1997, aiming to provide an up-to-date and comprehensive assessment of the TB epidemic and the progress made in prevention and treatment at all levels. The report does this in the context of targets, for example, the End TB strategy, which lays out goals to reduce TB mortalities by 90% and TB incidence by 80% by 2030, when compared with 2015.

In this year’s report, the data, which is collected from 201 countries covering 99% of the world’s population, estimated 10.4 million new cases of TB in 2016, with India, Indonesia, China, the Philippines and Pakistan accounting for 56% of these. In addition, it was reported that there were an estimated 1.3 million mortalities from TB in HIV negative individuals, a reduction from 1.7 million in 2000.

The report also highlighted several issues currently facing the prevention and treatment of this disease. The first is diagnosis – 2016 saw 6.3 million new cases of TB diagnosed, only 61% of the estimated incidence of 10.4 million, demonstrating there are still large gaps between detection and treatment that need to be addressed.

In addition, it was highlighted that drug-resistance is a continuing threat. Specifically, 2016 saw 600,000 new cases of TB that were resistant to rifampicin, the most effective first-line drug.

Overall, the report stated that although progress has been made, it is not being made fast enough. For example, currently TB incidence rates are falling at 2% per year and mortality rates by 3% per year; this will need to be increased by 4–5% per year by 2020 to reach the first milestones laid out in End TB strategy.

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Achieving targets will require multi-sectoral action and technological advances, particularly in a subset of high-burden countries, and factors heavily tied to TB will need to be addressed, including HIV, poverty and undernutrition. In addition, currently TB suffers from a funding gap, and going forwards more resources will be required from both domestic sources and international donors. The report states that investment in research and development is particularly necessary to develop new diagnostics, drugs, regimens and vaccines.

November 2017 will see the WHO Global Ministerial Conference on ending TB in the SDG era, followed by the first UN General Assembly high-level meeting on TB later in 2018. It is thought these meetings will provide a historic opportunity to cement the political commitment needed to step up our fight against TB, and ensure we remain on the path to end the epidemic.



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