World Health Organisation Global Progress Report on Tuberculosis Elimination 2019
On October 2019, the World Health Organisation (WHO) published the Global Tuberculosis Report. Tuberculosis is an infectious disease and a leading cause of death worldwide. In 2018, approximately 10 million people developed tuberculosis with the burden remaining high among marginalized and low-income countries. Approximately, 66% of new cases were found in India, China, Indonesia, Philippines, Pakistan, Nigeria, Bangladesh, and South Africa. Global leaders of low-income and high-income countries must accelerate progress to reach the third Sustainable Development Goal (SDG) of ending tuberculosis by 2030.
Though some progress has been made with mortality rates falling by 42% between 2000 and 2018, there is still a significant amount of work to be done. In 2018 over 7 million new tuberculosis cases were notified to national authorities and nearly 3 million people infected with tuberculosis are failing to receive sufficient care. The global treatment success rate for individuals with newly diagnosed tuberculosis was 85% in 2017. However, the treatment success rate for drug-resistant tuberculosis was only 56%. In 2018, approximately 417,000-556,000 people developed tuberculosis, which was resistant to rifampicin-resistant (RR-TB) and of those 78% developed multi-drug-resistant tuberculosis (MDR-TB). About 6% of those who developed MDR-TB also had extensively drug-resistant tuberculosis (XDR-TB). Almost 187,000 MDR/RR-TB cases were detected and notified in 2018, and only 156,000 started treatment with a second-line regime. Universal Health Coverage may assist in providing treatment to those who lack access to sufficient care.
In September 2019 the heads of states agreed to a political declaration on Universal Health Coverage at the United Nations. The declaration was aimed to address a range of issues including the ones listed above. Emphasis was placed on expanding service coverage and strengthening efforts to address communicable diseases such as tuberculosis, malaria, and HIV. The use of a people-centered comprehensive approach was suggested to aid in improving coverage. This may assist in successfully reaching the third SDG. The Global Tuberculosis Report included a tuberculosis SDG monitoring framework. The framework places attention on 14 indicators, which are associated with tuberculosis prevalence. Tuberculosis prevalence is also associated with diseases and lifestyle choices that lead to poor health outcomes.
Many new cases of tuberculosis are linked with smoking, diabetes, alcohol abuse and HIV. A focus on improving integrated HIV and tuberculosis programs may increase knowledge of HIV status in people diagnosed with tuberculosis. In 2018, approximately 477,000 HIV cases reported tuberculosis infection and 86% were on antiretroviral therapy. A significant proportion of the gaps in tuberculosis detection and treatment were located in the WHO African region. The WHO recommends preventative therapy for those with HIV infection and individuals who live in tuberculosis households. The report indicated nearly 49% of individuals recently enrolled in HIV care started tuberculosis preventative treatment. Additionally, only a quarter of those less than 5 years of age who are living in tuberculosis affected households receive preventative treatment.
Inadequate treatment and diagnosis are associated with poor resources such as workforce shortages and infrastructure. The workforce shortage is associated with inadequate funding. The funding required for a response to the tuberculosis epidemic (excluding research and development) was estimated at US$10.1 billion in 2019. However, only US$6.8 billion was available leaving a US$3.3 billion gap. An additional annual US$1.2 billion is required for research and development.
Between the years 2018-2019, a small number of new technologies have emerged yet many are not suitable for field evaluation studies. Technology still lacks a single rapid, robust and accurate tuberculosis diagnostic test that is appropriate for frontline point of care. The report also highlighted 23 drugs and combination treatments that are currently in clinical trials. Additionally, there are fourteen vaccine candidates currently in clinical trials. These vaccine candidates may improve outcomes of treatment for tuberculosis disease and prevent the development of latent TB infection.
Global tuberculosis report 2019. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO