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Stopping the body count: a comprehensive approach to move towards zero tuberculosis deaths

2015; Elsevier BV; Volume: 386; Issue: 10010 Linguagem: Inglês

10.1016/s0140-6736(15)00320-7

1474-547X

Salmaan Keshavjee, David W. Dowdy, Soumya Swaminathan,

HIV/AIDS Impact and Responses

Tuberculosis has been a curable disease since the 1950s. In the more than six decades since then, knowledge has been amassed about how to ameliorate its social causes, prevent its transmission, and treat both its clinical and quiescent forms. 1 Lönnroth K Jaramillo E Williams BG Dye C Raviglione M Drivers of tuberculosis epidemics: the role of risk factors and social determinants. Soc Sci Med. 2009; 68: 2240-2246 Crossref PubMed Scopus (629) Google Scholar , 2 Dye C Glaziou P Floyd K Raviglione M Prospects for tuberculosis elimination. Annu Rev Public Health. 2013; 34: 271-286 Crossref PubMed Scopus (261) Google Scholar In many high-income settings, this knowledge has been used with great success. Elsewhere, this is far from the case: more than 4000 people die from this curable and preventable airborne disease each day, mostly in low-income and middle-income settings. 3 WHOGlobal tuberculosis report 2014. World Health Organization, Geneva2014 Google Scholar Distressed by the status quo, in 2012 more than 500 scientists, policy makers, and advocates from around the world signed the Zero TB Declaration, which called for “a new global attitude” in the fight against tuberculosis, and argued that, with the right set of interventions, the planet could move rapidly towards zero deaths from tuberculosis. 4 Treatment Action GroupZero TB declaration. http://www.treatmentactiongroup.org/tb/advocacy/zero-declarationDate: July 22, 2012 Google Scholar Salmaan Keshavjee: tackling tuberculosis (without rocket science)Salmaan Keshavjee's CV is a puzzling document. A first degree in biochemistry from Queen's University in Ontario, Canada, is followed by a move to the USA and a master's in immunology and infectious diseases from the then Harvard School of Public Health. The next 5 years find him still at Harvard, but now doing a course in Middle Eastern Studies, and then writing a doctoral thesis in anthropology. 3 years on he's graduating from Stanford University, this time with a medical degree. Is this a man who can't make up his mind? Full-Text PDF Data for action: collection and use of local data to end tuberculosisAccelerating progress in the fight against tuberculosis will require a drastic shift from a strategy focused on control to one focused on elimination. Successful disease elimination campaigns are characterised by locally tailored responses that are informed by appropriate data. To develop such a response to tuberculosis, we suggest a three-step process that includes improved collection and use of existing programmatic data, collection of additional data (eg, geographic information, drug resistance, and risk factors) to inform tailored responses, and targeted collection of novel data (eg, sequencing data, targeted surveys, and contact investigations) to improve understanding of tuberculosis transmission dynamics. Full-Text PDF Turning off the tap: stopping tuberculosis transmission through active case-finding and prompt effective treatmentTo halt the global tuberculosis epidemic, transmission must be stopped to prevent new infections and new cases. Identification of individuals with tuberculosis and prompt initiation of effective treatment to rapidly render them non-infectious is crucial to this task. However, in settings of high tuberculosis burden, active case-finding is often not implemented, resulting in long delays in diagnosis and treatment. A range of strategies to find cases and ensure prompt and correct treatment have been shown to be effective in high tuberculosis-burden settings. Full-Text PDF Controlling the seedbeds of tuberculosis: diagnosis and treatment of tuberculosis infectionThe billions of people with latent tuberculosis infection serve as the seedbeds for future cases of active tuberculosis. Virtually all episodes of tuberculosis disease are preceded by a period of asymptomatic Mycobacterium tuberculosis infection; therefore, identifying infected individuals most likely to progress to disease and treating such subclinical infections to prevent future disease provides a crucial opportunity to interrupt tuberculosis transmission and reduce the global burden of tuberculosis disease. Full-Text PDF Stopping tuberculosis: a biosocial model for sustainable developmentTuberculosis transmission and progression are largely driven by social factors such as poor living conditions and poor nutrition. Increased standards of living and social approaches helped to decrease the burden of tuberculosis before the introduction of chemotherapy in the 1940s. Since then, management of tuberculosis has been largely biomedical. More funding for tuberculosis since 2000, coinciding with the Millennium Development Goals, has yielded progress in tuberculosis mortality but smaller reductions in incidence, which continues to pose a risk to sustainable development, especially in poor and susceptible populations. Full-Text PDF Tuberculosis controlWe are responding to the Comment by Salmaan Keshavjee and colleagues,1 who contend that the narrow focus on patients who access care on their own (passive case finding) contributes to poor tuberculosis control. Although this is partly true, it is not passive case finding, but rather the absence of adequate systems to ensure initiation of treatment in national tuberculosis programmes that is the major problem. Full-Text PDF Tuberculosis controlThe Lancet Series How to eliminate tuberculosis1 rightly acknowledges that the present situation is untenable. The Series complements the Global Plan to End TB, 2016–2020,2 released by the Stop TB Partnership on Nov 20, 2015. The Global Plan to End TB, 2016–2020 is designed to accelerate progress necessary to fulfil the WHO End TB Strategy,3 which the World Health Assembly endorsed in 2014 and which aims to end the epidemic of tuberculosis by 2035. Full-Text PDF