Dr Katherine Floyd, of WHO’s Global TB Programme, reviewed the findings of the Global Report and importantly, where the gaps are
As noted in a previous post, the Global Report listed 5 priorities to accelerate and/or move beyond the 2015 TB targets:
1. Reach the ‘missed cases’
2. Address MDR-TB as a public health crisis
3. Accelerate response to the TB/HIV co-epidemic
4. Increase domestic and donor funding to close resource gaps
5. Rapidly uptake innovations.
Dr Floyd highlighted points one and four.
“Where are the missed cases?” she asked rhetorically. What is shocking is that 75% are in twelve countries — three of them middle-income BRICS economies. The most, by far, are in India, followed by South Africa, Bangladesh, Pakistan, Indonesia, China, the Democratic Republic of Congo, Mozambique, Nigeria, Ethiopia, Philippines and Myanmar.
The problem in India may not so much be that people aren’t being diagnosed, but that they are being diagnosed [perhaps by the private sector] but the cases are not being notified, Dr Floyd said, and there are doubts about the quality of treatment these individuals are prescribed outside of the public sector.
“There are some other countries where there are probably some serious problems with access,” she said. For example, the recently completed NTP national prevalence survey in Nigeria suggests that there are some problems providing access to basic diagnosis and treatment services.
With regards to funding needs, projections suggest some very different pictures depending on which high burden countries one looks at. For instance, in the BRICS countries, that include Russia, India, China and South Africa — which account for 45% of the global TB burden — there is actually quite a strong capacity to mobilise domestic resources, and the same is true of other middle-income countries.
There are other low-income countries where that capacity does not exist, and international donor support must be sought: with estimates ranging between $1.6 to $3 billion dollars of international funding each year.
Dr Raviglione describes the milestones and the proposed pillars and pillars of the new global TB strategy
The goal of the new Global Strategy is the end of the global TB epidemic, Dr Raviglione told the crowd. But the strategy sets milestones along the path.
By 2020
- There should be a 35% reduction in TB deaths
- A 20% reduction in TB incidence rate (<85/100,000)
- No affected families experiencing catastrophic costs due to TB
By 2025
- A 75% reduction in TB deaths
- A 50% reduction in TB incidence rate (<55/100,000
- No affected families experiencing catastrophic costs due to TB
By 2030
- There should be a 90% reduction in TB deaths
- An 80% reduction in TB incidence rate (<20/100,000)
- No affected families experiencing catastrophic costs due to TB
By 2035
- There should be a 95% reduction in TB deaths
- An 90% reduction in TB incidence rate (<10/100,000)
- No affected families experiencing catastrophic costs due to TB
“We are ready, as the TB community, to give [the UN and the member countries] the strategy and say: These are the targets and all of the trajectory, so please adopt these targets,” said Dr Raviglione.
There are four basic principles to the new global TB strategy:
- Government stewardship, accountability and monitoring and evaluation systems to track progress towards the targets
- Building a strong coalition with civil society and communities – “You have seen an example of this, this morning, and I hope this continues,” said Dr Raviglione.
- Protecting and promoting human rights, ethics and equity
- Adaptation of the strategy and targets at the country level with global – or international — collaboration. Because (as noted by Dr Floyd) many countries are in need of support.
Success of the strategy will also depend upon three pillars:
Innovative TB care
- This means rapid diagnosis of TB including universal drug susceptibility testing; systematic screening of people in close contact to people with TB, and population groups at high risk of TB
- Treatment of all forms of TB, including drug resistant TB with support for patients
- Collaborative TB/HIV activities and management of co-morbidities
- Preventive treatment for high risk groups and childhood vaccination.
Bold policies and support systems
- Government stewardship, commitment and adequate resources for TB care and control with monitoring and evaluation
- Engagement of communities, civil society organisation and all public care providers
- Universal Health Coverage policy and a regulatory framework for vital registration, case notification, to ensure the quality of TB drugs and their rational use, and TB infection control
- Social protection, poverty alleviation and other measures to address social determinants of TB
Intensified research
- Discovery, development and rapid uptake of new tools and innovations (new diagnostics, drugs and vaccines
- Operational research to optimise implementation and promote innovations