Tuberculosis

• The Stop TB Strategy, the Global Plan to Stop TB, 2006 – 2015 and targets for TB control
• Global and regional incidence

The Stop TB Strategy, the Global Plan to Stop TB, 2006 – 2015 and targets for TB control

In 2006, WHO launched the new Stop TB Strategy. The core of this strategy is DOTS, the TB control approach introduced by WHO in 1995. Since then, more than 22 million patients have been treated under DOTS-based services. The new six-point strategy builds on this success, while recognizing the key challenges of TB/HIV and MDR-TB. It also responds to access, equity and quality constraints, and adopts evidence-based innovations in engaging with private health-care providers, empowering affected people and communities and helping to strengthen health systems and promote research.
The six components of the Stop TB Strategy are:

• Pursuing high-quality DOTS expansion and enhancement. Making high-quality services widely available and accessible to all those who need them, including the poorest and most vulnerable, requires DOTS expansion to even the remotest areas. In 2004, 183 countries (including all 22 of the high-burden countries which account for 80% of the world's TB cases) were implementing DOTS in at least part of the country.
• Addressing TB/HIV, MDR-TB and other challenges. Addressing TB/HIV, MDR-TB and other challenges requires much greater action and input than DOTS implementation and is essential to achieving the targets set for 2015, including the United Nations Millennium Development Goal relating to TB (Goal 6; Target 8).
• Contributing to health system strengthening. National TB control programmes must contribute to overall strategies to advance financing, planning, management, information and supply systems and innovative service delivery scale-up.
• Engaging all care providers. TB patients seek care from a wide array of public, private, corporate and voluntary health-care providers. To be able to reach all patients and ensure that they receive high-quality care, all types of health-care providers are to be engaged.
• Empowering people with TB, and communities. Community TB care projects have shown how people and communities can undertake some essential TB control tasks. These networks can mobilize civil societies and also ensure political support and long-term sustainability for TB control programmes.
• Enabling and promoting research. While current tools can control TB, improved practices and elimination will depend on new diagnostics, drugs and vaccines.

The strategy is to be implemented over the next 10 years as described in the Global Plan to Stop TB, 2006 – 2015. The Global Plan is a comprehensive assessment of the action and resources needed to implement the Stop TB Strategy and to achieve the following targets:

• Millennium Development Goal (MDG) 6, Target 8: Halt and begin to reverse the incidence of TB by 2015
• Targets linked to the MDGs and endorsed by the Stop TB Partnership:
• by 2005: detect at least 70% of new sputum smear-positive TB cases and cure at least 85% of these cases
• by 2015: reduce TB prevalence and death rates by 50% relative to 1990

Progress towards targets

In 2004, an estimated 53% of new smear-positive cases were detected under DOTS. This proportion, which increased steadily from 1995 to 2000, has increased more rapidly each year since 2001, and is likely to have exceeded 60% in 2005 – just short of the 70% target.

Treatment success in the 2003 DOTS cohort of 1.7 million patients was 82% on average, edging closer to the 85% target. To reach the target of 85% treatment success globally, a special effort must be made to improve cure rates in the African and European regions.

The 2006 WHO report Global TB Control concluded that three (of six) WHO regions are likely to have met both the 2005 targets: the Region of the Americas and the South-East Asia and Western Pacific regions. Seven of the 22 high-burden countries are likely to have met the 2005 targets: Cambodia, China, India, Indonesia, Myanmar, the Philippines and Viet Nam.

If the Stop TB Strategy is implemented as set out in the Global Plan, the resulting improvements in TB control should reverse the rise in TB incidence by 2015, and halve prevalence and death rates in all regions except Africa and Eastern Europe.