THE END TB STRATEGY G lobal strategy and targets for tuberculosis prevention, care and control after 2015a [A67/11 – 14 March 2014] THE END TB STRATEGY Global strategy and targets for tuberculosis prevention, care and control after 2015a [A67/11 – 14 March 2014] WHO’s declaration of tuberculosis as a global In May 2012, Member States at the Sixty- public health emergency in 1993 ended a fifth World Health Assembly requested the period of prolonged global neglect. Together, DirectorGeneral to submit a comprehensive the subsequent launch of the directly observed review of the global tuberculosis situation treatment, short course (DOTS) strategy; to date, and to present new multisectoral inclusion of tuberculosis-related indicators strategic approaches and new international in the Millennium Development Goals; targets for the post-2015 period to the Sixty- development and implementation of the seventh World Health Assembly in May 2014, Stop TB Strategy that underpins the Global through the Executive Board.b The work to Plan to Stop TB 2006–2015; and adoption of prepare this has involved a wide range of resolution WHA62.15 on the prevention and partners providing substantive input into the control of multidrug-resistant tuberculosis and development of the new strategy, including extensively drug-resistant tuberculosis by the high-level representatives of Member States, Sixty-second World Health Assembly have all national tuberculosis programmes, technical helped to accelerate the global expansion of and scientific institutions, financial partners tuberculosis care and control. and development agencies, civil society, nongovernmental organizations, and the private sector. b See document WHA65/2012/REC/3, summary record of the a See resolution WHA67.1. sixth meeting of Committee B, section 3. 1 The process. WHO’s Strategic and Technical the opening day of the Conference at the Advisory Group for Tuberculosis approved global tuberculosis symposium, which was the broad, inclusive scope of the consultative attended by over 700 stakeholders. In 2013, process for the development of the draft strategy. three special consultations including senior It began with a web-based consultation to seek officials of Member States, technical experts ways in which to strengthen the current strategy and civil society were organized in order and introduce any new components. During to discuss (i) formulation of the post-2015 2012, as part of the annual meetings of national tuberculosis targets; (ii) approaches to building tuberculosis programmes, each regional office on the opportunities presented by expansion of organized consultations on the proposed universal health coverage and social protection new strategic framework and targets with to strengthen tuberculosis care and prevention; health ministry officials, national tuberculosis and (iii) research and innovation for improved programme managers and partners. Officials of tuberculosis care, control and elimination. In countries with a high tuberculosis burden then June 2013, the Strategic and Technical Advisory deliberated on the draft strategic framework at Group for Tuberculosis endorsed the draft, a special consultation organized just before the including the global targets and their rationale.c 43rd Union World Conference (Kuala Lumpur, 13–17 November 2013). Following this, the The framework of the post-2015 global framework was presented and discussed on tuberculosis strategy is presented in Figure 1. Figure 1. POST-2015 GLOBAL TUBERCULOSIS STRATEGY FRAMEWORK VISION A world free of tuberculosis – zero deaths, disease and suffering due to tuberculosis GOAL End the global tuberculosis epidemic MILESTONES FOR 2025 75% reduction in tuberculosis deaths (compared with 2015) 50% reduction in tuberculosis incidence rate (less than 55 tuberculosis cases per 100 000 population) – No affected families facing catastrophic costs due to tuberculosis TARGETS FOR 2035 95% reduction in tuberculosis deaths (compared with 2015) 90% reduction in tuberculosis incidence rate (less than 10 tuberculosis cases per 100 000 population) – No affected families facing catastrophic costs due to tuberculosis PRINCIPLES 1. Government stewardship and accountability, with monitoring and evaluation 2. Strong coalition with civil society organizations and communities 3. Protection and promotion of human rights, ethics and equity 4. Adaptation of the strategy and targets at country level, with global collaboration PILLARS AND COMPONENTS 1. INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION A. Early diagnosis of tuberculosis including universal drug-susceptibility testing, and systematic screening of contacts and high-risk groups B. Treatment of all people with tuberculosis including drug-resistant tuberculosis, and patient support C. Collaborative tuberculosis/HIV activities, and management of comorbidities D. Preventive treatment of persons at high risk, and vaccination against tuberculosis 2. BOLD POLICIES AND SUPPORTIVE SYSTEMS A. Political commitment with adequate resources for tuberculosis care and prevention B. Engagement of communities, civil society organizations, and public and private care providers C. Universal health coverage policy, and regulatory frameworks for case notification, vital registration, quality and rational use of medicines, and infection control D. Social protection, poverty alleviation and actions on other determinants of tuberculosis 3. INTENSIFIED RESEARCH AND INNOVATION A. Discovery, development and rapid uptake of new tools, interventions and strategies B. Research to optimize implementation and impact, and promote innovations 2 APPROACHES Expandingccare, strengthening prevention, delivery of tuberculosis care and prevention. and intensifying research. Addressing the Above them are the national health ministries above challenges will require innovative, that provide critical systemic support, enforce multisectoral, and integrated approaches. The regulatory mechanisms, and coordinate DOTS strategy strengthened public sector integrated approaches through interministerial tuberculosis programmes to help to tackle a and intersectoral collaboration. Above all, large burden of drugsusceptible disease. The the national governments have to provide Stop TB Strategy,d built on DOTS, helped to the overall stewardship to keep tuberculosis begin addressing drugresistant tuberculosis elimination high on the development agenda and HIV-associated tuberculosis while through political commitment, investments and promoting research to develop new tools. It oversight, while making rapid progress towards also helped to expand partnerships with all universal health coverage and social protection. care providers, civil society organizations and communities, in the context of strengthening Elevating leadership and widening ownership. health systems. Ending the tuberculosis Tuberculosis care and control need to be epidemic will require further expansion of strengthened further and expanded to include the scope and reach of interventions for prevention of tuberculosis. For this purpose, tuberculosis care and prevention; institution in-country leadership for tuberculosis control of systems and policies to create an enabling ought to be elevated to higher levels within environment and share responsibilities; and health ministries. This is essential in order to aggressive pursuit of research and innovation effect coordinated action on multiple fronts to promote development and use of new tools and to accomplish three clear objectives: for tuberculosis care and prevention. It will also (1) achieving universal access to early detection require a provision for revisiting and adjusting and proper treatment of all patients with the new strategy based on progress and the tuberculosis; (2) putting supportive health and extent to which agreed milestones and targets social sector policies and systems in place to are being met. enable effective delivery of tuberculosis care and prevention; and (3) intensifying research to Eliciting systemic support and engaging develop and apply new technologies, tools and stakeholders. In practical terms, continuing approaches to enable eventual tuberculosis progress beyond 2015 will require intensified elimination. The three pillars of the global actions by and beyond tuberculosis tuberculosis strategy are designed to address programmes within and outside the health these objectives. sector. The new strategy envisages concrete actions from three levels of governance in close collaboration with all stakeholders and with the engagement of communities. At the core are national tuberculosis programmes or the equivalent structures that are responsible for coordination of all activities related to c Strategic and Technical Advisory Group for Tuberculosis: report of 13th meeting, 11–12 June 2013 (document WHO/ HTM/TB/2013.9). d The six components of the Stop TB Strategy are: (i) pursue high-quality DOTS expansion and enhancement; (ii) address TB/HIV, MDR-TB and other special challenges; (iii) contribute to health system strengthening; (iv) engage all care providers; (v) empower people with tuberculosis, and communities; and (vi) enable and promote research. 3 VISION, GOAL, MILESTONES AND TARGETS The vision for the post-2015 global tuberculosis 2030. Table 1 presents key global indicators, strategy is “a world free of tuberculosis”, milestones and targets for the post-2015 also expressed as “zero deaths, disease and strategy. suffering due to tuberculosis”. The goal is to end the global tuberculosis epidemic.