Progress towards TB reduction targets is faltering, report finds

BMJ 2017; 359 doi: (Published 13 October 2017) Cite this as: BMJ 2017;359:j4758
  1. Sophie Cousins

Less than half of the 10.4 million people who develop tuberculosis (TB) each year are being successfully treated, according to a new report.1

The 90-(90)-90 Tuberculosis Report for Heads of State and Governments, published by Stop TB Partnership, found that global progress towards reaching the “90-(90)-90” goals is faltering.

The 90-(90)-90 goals, as part of the Global Plan to End TB 2016-2020, aim to ensure that 90% of all people with TB have been diagnosed and receive treatment; 90% of the most vulnerable populations are diagnosed and treated; and 90% of those diagnosed successfully complete treatment by 2020.

But according to the report, no country has achieved both 90% treatment coverage and 90% treatment success. And none of the high TB or drug resistant TB (DR TB) burden countries have achieved 90% treatment coverage for first or second line TB treatment.

The report shows that only 59% of people who developed TB and less than one in five who developed DR TB were diagnosed and put on treatment in 2015. But because of poor treatment rates, only one in 10 people with DR TB were successfully treated and of the 59% of people who were put on first line treatment, 83% were treated successfully.

Experts told The BMJ that the lack of progress calls into question both the goals and the World Health Organisation’s End TB strategy, which aims to end the epidemic by 2035.

Madhu Pai, TB expert and professor of epidemiology at McGill University in Montreal, said the goals would be difficult to reach.

“90-(90)-90 by 2020 looks very challenging unless there is serious support from national leaders and policy makers, big increases in financing, and a huge outcry from the patient and advocacy community to hold national TB programmes and health ministries accountable,” he said. “I hope the quality of TB care will become a key issue as mere coverage isn’t enough—quality of care also matters for good outcomes.”

Meanwhile, the Roadmap for Zoonotic TB was launched by WHO, the Food and Agriculture Organisation of the United Nations, the World Organisation for Animal Health, and the International Union Against Tuberculosis and Lung Disease at the 48th Union World Conference on Lung Health in Guadalajara, Mexico.

There were an estimated 147 000 cases of zoonotic TB in 2016 and 12 500 deaths.

But treating the disease is hampered by myriad challenges including difficulties in differentiating M. tuberculosis from M. bovis. Zoonotic TB is naturally resistant to one of the four first line anti-TB drugs.

The Roadmap identifies 10 priority areas for tackling zoonotic B, with specific goals for 2020 and 2025.

Some of the 2020 goals include improved detection; recording and reporting of zoonotic and bovine TB to allow for more accurate estimations of the disease burden; improved national food safety standards; and community education campaigns to raise awareness of foodborne diseases.

2025 goals include new rapid diagnostic tools; appropriate drug regimens; and an effective bovine TB vaccine for livestock in endemic settings.

Paula Fujiwara, scientific director of the Union who was involved with the Roadmap, admitted the goals were ambitious. “If we don’t have new tools, then forget it—and that’s not just for bovine TB, I’m talking about TB in general. We need new diagnostics, new regimens that work together, and a vaccine,” she told The BMJ.

“We need to aspire to the End TB 2035 goal but I don’t know what’s going to happen.”


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