Abstract
The international community has committed to ending the tuberculosis (TB) epidemic by 2030. This will require multi-sectoral action with a focus on accelerating socio-economic development, developing and implementing new tools, and expanding health insurance coverage. Within this broad framework, National TB Programmes (NTPs) are accountable for delivering diagnostic, treatment, and preventive services. There are large gaps in the delivery of these services, and the aim of this article is to review the crucial activities and interventions that NTPs must implement in order to meet global targets and milestones that will end the TB epidemic. The key deliverables are the following: turn End TB targets and milestones into national measurable indicators to make it easier to track progress; optimize the prompt and accurate diagnosis of all types of TB; provide rapid, complete, and effective treatment to all those diagnosed with TB; implement and monitor effective infection control practices; diagnose and treat drug-resistant TB, associated HIV infection, and diabetes mellitus; design and implement active case finding strategies for high-risk groups and link them to the treatment of latent TB infection; engage with the private-for-profit sector; and empower the Central Unit of the NTP particularly in relation to data-driven supportive supervision, operational research, and sustained financing. The glaring gaps in the delivery of TB services must be remedied, and some of these gaps will require new paradigms and ways of working which include patient-centered and higher-quality services. There must also be fast-track ways of incorporating new diagnostic, treatment, and prevention tools into program activities so as to rapidly reduce TB incidence and mortality and meet the goal of ending TB by 2030.
Highlights
If you always do what you always did, you will always get what you always got
The “DOTS” strategy launched by the World Health Organization (WHO) in 1995, which evolved into the “Stop TB” Strategy a decade later and the “End TB” Strategy, has provided the successive frameworks and targets for international and national control efforts
Community- or home-based DOT is recommended, and DOT by trained community volunteers/workers or formal health-care workers is preferred over DOT that is administered by family members
Summary
If you always do what you always did, you will always get what you always got. The Sustainable Development Goals (SDGs), adopted by United Nations (UN) Member States in September 2015, and the World Health Organization (WHO) End TB Strategy, endorsed by the WHO’s 194 Member States in 2014, have a common goal with respect to tuberculosis (TB): to end the global TB epidemic. An important monitoring indicator for effective implementation within health facilities is the number and proportion of health-care workers who develop TB each year, and this should be routinely reported by NTPs. Diagnose and promptly treat drug-resistant tuberculosis Both RR/MDR-TB require prolonged treatment (traditionally up to 24 months) with second-line anti-TB drugs, which are less effective and more costly and are associated with more adverse events compared with first-line drugs (Table 5)[38,39]. A new screening approach in Malawi and South Africa showed that testing people living with HIV and admitted to hospital with urine LAM and urine Xpert MTB/RIF in addition to sputum Xpert MTB/RIF resulted in increased overall TB diagnosis and treatment and reduced mortality in key subgroups[84]. NTPs in low- and middle-income countries need to emphasize that the diagnosis and treatment of drug-sensitive and drug-resistant TB are very cost-effective when compared with the economic cost and productivity losses that may result from the disease[108]
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