Authors: Martha Powell, Future Science Group
This year’s global TB report has been published in the lead-up to the United Nations’ (UN) first-ever high-level meeting on tuberculosis, which hopes to highlight the need for immediate action to accelerate progress towards the goal of ending the TB epidemic by 2030.
In 2017, it was estimated that TB caused 1.3 million deaths among HIV-negative individuals, with an additional 300,000 mortalities in those who were HIV-positive. In addition, the report estimates 10 million new cases of TB globally in 2017: 5.8 million in men, 3.2 million in women and 1 million in children, with two thirds of these occurring in just eight countries, including India and China.
Drug resistance continues to be a crisis in TB. Worldwide in 2017, 558,000 individuals developed rifampicin-resistant TB and of these, 82% had multi-drug resistant TB. Moreover, of the 558,000 individual who developed drug-resistant TB in 2017, only 25% were enrolled on treatment with a second-line regimen. Higher drug susceptibility testing will be crucial long with care models to support continued treatment and new medicines and regimens.
Falling burden – but falling fast enough?
The disease burden caused by TB is falling in all WHO regions and most countries, however, it is currently not decreasing fast enough to reach the 2020 milestones of the End TB Strategy. For example, currently the incidence rate is falling at approximately 2% a year, by 2020 this needs to be falling at 4–5% a year.
Diagnostic and treatment gaps
The report highlights large and persistent gaps in detection and treatment, for example, in 2017 6.4 million new cases of TB were reported to the WHO, only 64% of the estimated 10 million new cases. The WHO, Stop TB Partnership and Global Fund have launched an initiative to support the closing of these gaps – a result of underreporting and underdiagnosis – which aims to detect and treat 40 million people with TB between 2018 and 2022.
A spotlight on social determinants
By 2025, TB incidence needs to be falling by 10%, the WHO state that this can only be achievable in the context of universal healthcare, along with addressing the social and economic factors that drive TB. It is suggested that eliminating extreme poverty and providing social protection could substantially reduce TB burden.
Actions needed to accelerate progress
Accelerating progress towards TB elimination requires closing the diagnosis, treatment and prevention in addition to addressing to social and economic determinants and consequences of TB. Moreover, research and development in TB is required to accelerate the slowly progressing pipelines. For all of this increased and sustained funding will be necessary.
Despite the falling incidence of TB, more needs to be done to push this disease towards eliminations. The UN high-level meeting, with its attendance of heads of state and other political minds, provides a platform to step up the commitments and actions necessary to end the global TB epidemic by 2030.
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