WHO End TB Strategy 2016 - 2035
In 2014 the World Health Assembly adopted the World Health Organisation (WHO)’s “Global strategy and targets for tuberculosis prevention, care and control after 2015″1“Global strategy and targets for tuberculosis prevention, care and control after 2015”, WHO, Geneva, 2015, http://www.who.int/tb/post2015_strategy/en/. This twenty year strategy aims to end the global TB epidemic and is unsurprisingly called the End TB Strategy. Ending TB is defined as an incidence rate of less than 10 people per 100,000 population per year. The incidence rate is the number of new cases of active TB disease in a population in a particular time period.
The main targets in the End TB Strategy are:
- To reduce TB deaths by 95%
- To cut new cases of TB by 90% between 2015 and 2035
- To ensure that no family is burdened with catastrophic expenses due to TB.
Global Plan to End TB 2016 - 2020
In contrast to the WHO’s Global Strategy, the Global Plan produced by the Stop TB Partnership, sets out the actions and resources needed for the first five years, to enable the global TB epidemic to be ended by 2030. It aims to end the complacency that has existed for so long, and the belief that we can, for example, be satisfied with small scale changes in global incidence, as a measure of success. The Global Plan strongly suggests that there must be a major change in how people regard TB care and prevention, and it provides a blueprint for what must be done. The Global Plan to End TB has the potential of enabling the milestones and targets of the Global TB Strategy to be reached if it is fully resourced and implemented.
The Global Plan is an attempt to end the “business as usual” approach to combating TB, and to change what people believe is possible. Over the years a variety of plans and targets have been produced and at best the targets have only been partially met. The Global Plan is an attempt to change this approach. For people to believe that they can end TB. To believe that there is no need for a million and a half people to die from TB each year.
Global Plan Targets
At it’s core the Global Plan is about improving the reach and quality of medical treatment for TB. There is enormous scope for this to be done. Three targets have been set and it is estimated that if these targets are achieved by 2025 at the latest, then the goal to end TB will be met. The Global Plan therefore recommends that the targets should be achieved as soon as possible, ideally by 2020, and at the latest, by 2025.
Target 1 Reach 90% of all people with TB
and place all of them on appropriate therapy. Currently of the nine million people who fall ill each year more than three million are not reached through national TB programmes. They may not receive proper diagnosis or TB treatment. Of those who do receive treatment 86% have a successful recovery. The treatment could be first line, second line or preventative TB therapy.
This requires early detection and the prompt treatment of 90% of people with TB, including both drug susceptible and drug resistant TB. It also requires preventative treatment to be provided to 90% of those who need it. Preventative treatment is providing treatment to people with latent TB before it progresses to TB disease. Examples of people who need it are people living with HIV/AIDS and people in contact with TB patients.
By improving the rates at which people are diagnosed and treated, countries can reduce the spread of TB and drive down incidence.
Target 2 As part of this approach reach at least 90% of the key populations
who are the most vulnerable and under served at risk populations. Vulnerable, under served, at risk populations vary depending on country context. But in all cases these key populations are more frequently missed by health systems. They are often unable to access health services, or suffer particularly detrimental consequences as a result of TB. The purpose of Target 2 is also to provide treatment and care through affordable programmes that protect patients and their families from the often catastrophic costs associated with TB.
The Global Plan recommends that each national TB programme should work with communities affected by TB to define its key populations, to plan and implement appropriate services, and to measure progress towards reaching these populations.
Target 3 Achieve at least 90% treatment success for all people diagnosed with TB
through affordable treatment services. The correct treatment must be provided along with adherence and social support. At least 480,000 people develop drug resistant TB each year and less than 20% of them receive proper treatment. As a result only around half of those who become ill with TB have the possibility of being cured. Also, when they do become ill they have the possibility of passing on TB and so continuing the global epidemic.
Target 3 aims to ensure the quality treatment, support and follow-up needed to achieve at least a 90% treatment success rate among people identified as needing treatment. This includes treatment for drug susceptible TB, drug resistant TB or preventative TB therapy.
Following the first Global Ministerial conference on TB in 2017 and in advance of the UN high level meeting on TB in 2018, WHO, the Stop TB Partnership and the GLobal Fund to Fight AIDS, Tuberculosis and Malaria have launched a joint initiative to scale up the End TB response towards universal access to TB prevention and care. The initiative is for the five year period 2018 - 2022.
The initiative includes a target to diagnose, treat and report 40 million people with TB, including 3.5 million children and 1.5 million people with drug resistant TB between 2018 and 2022.
The initiative encompasses all countries, with priority given to the 30 high TB burden countries.
Paradigm Shift - A fundamental change
Starting with the Global Plan to Stop TB 2001 - 2005 there have been at least three other global plans which have failed to reach and treat enough people with TB to make a success of the plan. Often when the target date is reached the existing global plan is given a new target date, a new name, and much the same approach is used with the new plan. So what is going to change.
Why is this Global Plan going to be any different?
This plan could be more successful because more people will be treated. There could be more of a commitment to treat more people with TB, to stop them becoming infectious earlier, and as a result prevent them from infecting so many other people.
More people could be treated successfully because shorter treatment plans are being developed, which are easier to adhere to. New tests for TB are being developed, as well as new TB drugs. It is easier to find and test people in the high burden TB countries. All of these things will help to prevent people from dying of TB
Finally, there is the matter of HIV/AIDS. HIV/AIDS has shown what can be done. It has shown how HIV/AIDS treatment with specialist drugs can be provided, and people can be prevented from dying. Why isn’t the same being done for TB?
Can the TB community make the effort, and provide the money and other resources to do the same? If not then why not? Are we prepared to go on allowing more than one million people to die unnecessarily each year.