Scaling up interventions to achieve global tuberculosis control: progress and new developments

• Published in: The Lancet (British edition) Vol. 379; no. 9829; pp. 1902 - 1913
• Main Authors: Raviglione, Mario, Marais, Ben, Floyd, Katherine, Lönnroth, Knut, Getahun, Haileyesus, Migliori, Giovanni B, Harries, Anthony D, Nunn, Paul, Lienhardt, Christian, Graham, Steve, Chakaya, Jeremiah, Weyer, Karin, Cole, Stewart, Kaufmann, Stefan HE, Zumla, Alimuddin
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 19.05.2012; Elsevier; Elsevier Limited
• Subjects: Africa; alcohols; Antiretroviral agents; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Biomarkers - analysis; Biomedical Research - trends; Communicable Disease Control - methods; Community Health Services - organization & administration; death; diabetes mellitus; diagnostic techniques; drug resistance; drugs; Estimates; Financing, Organized; Forecasting; General aspects; Global Health; Grants; Health services; HIV; HIV Infections - complications; HIV Infections - mortality; Human bacterial diseases; Human immunodeficiency virus; Humans; Incidence; Infectious diseases; Internal Medicine; issues and policy; Medical sciences; Miscellaneous; Mortality; Mycobacterium; Population levels; Prevalence; Public health. Hygiene; Public health. Hygiene-occupational medicine; risk; Risk reduction; Social Support; Tuberculosis; Tuberculosis - complications; Tuberculosis - mortality; Tuberculosis - prevention & control; Tuberculosis and atypical mycobacterial infections; Tuberculosis Vaccines; Tuberculosis, Multidrug-Resistant - mortality; Tuberculosis, Multidrug-Resistant - prevention & control; uncertainty; Vaccines; Africa; Infection; Medicine; Innovation; Tuberculosis; Bacteriosis; Development; Mycobacterial infection; Sanitary surveillance
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(12)60727-2

Tuberculosis is still one of the most important causes of death worldwide. The 2010 Lancet tuberculosis series provided a comprehensive overview of global control efforts and challenges. In this update we review recent progress. With improved control efforts, the world and most regions are on track to achieve the Millennium Development Goal of decreasing tuberculosis incidence by 2015, and the Stop TB Partnership target of halving 1990 mortality rates by 2015; the exception is Africa. Despite these advances, full scale-up of tuberculosis and HIV collaborative activities remains challenging and emerging drug-resistant tuberculosis is a major threat. Recognition of the effect that non-communicable diseases—such as smoking-related lung disease, diet-related diabetes mellitus, and alcohol and drug misuse—have on individual vulnerability, as well as the contribution of poor living conditions to community vulnerability, shows the need for multidisciplinary approaches. Several new diagnostic tests are being introduced in endemic countries and for the first time in 40 years a coordinated portfolio of promising new tuberculosis drugs exists. However, none of these advances offer easy solutions. Achievement of international tuberculosis control targets and maintenance of these gains needs optimum national health policies and services, with ongoing investment into new approaches and strategies. Despite growing funding in recent years, a serious shortfall persists. International and national financial uncertainty places gains at serious risk. Perseverance and renewed commitment are needed to achieve global control of tuberculosis, and ultimately, its elimination.