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Review
. 2015 Apr;45(4):928-52.
doi: 10.1183/09031936.00214014.

Towards tuberculosis elimination: an action framework for low-incidence countries

Knut Lönnroth  1 , Giovanni Battista Migliori  2 , Ibrahim Abubakar  3 , Lia D'Ambrosio  4 , Gerard de Vries  5 , Roland Diel  6 , Paul Douglas  7 , Dennis Falzon  8 , Marc-Andre Gaudreau  9 , Delia Goletti  10 , Edilberto R González Ochoa  11 , Philip LoBue  12 , Alberto Matteelli  8 , Howard Njoo  9 , Ivan Solovic  13 , Alistair Story  14 , Tamara Tayeb  15 , Marieke J van der Werf  16 , Diana Weil  8 , Jean-Pierre Zellweger  17 , Mohamed Abdel Aziz  18 , Mohamed R M Al Lawati  19 , Stefano Aliberti  20 , Wouter Arrazola de Oñate  21 , Draurio Barreira  22 , Vineet Bhatia  8 , Francesco Blasi  23 , Amy Bloom  24 , Judith Bruchfeld  25 , Francesco Castelli  26 , Rosella Centis  4 , Daniel Chemtob  27 , Daniela M Cirillo  28 , Alberto Colorado  29 , Andrei Dadu  30 , Ulf R Dahle  31 , Laura De Paoli  32 , Hannah M Dias  8 , Raquel Duarte  33 , Lanfranco Fattorini  34 , Mina Gaga  35 , Haileyesus Getahun  8 , Philippe Glaziou  8 , Lasha Goguadze  36 , Mirtha Del Granado  37 , Walter Haas  38 , Asko Järvinen  39 , Geun-Yong Kwon  40 , Davide Mosca  41 , Payam Nahid  42 , Nobuyuki Nishikiori  43 , Isabel Noguer  44 , Joan O'Donnell  45 , Analita Pace-Asciak  46 , Maria G Pompa  47 , Gilda G Popescu  48 , Carlos Robalo Cordeiro  49 , Karin Rønning  31 , Morten Ruhwald  50 , Jean-Paul Sculier  51 , Aleksandar Simunović  52 , Alison Smith-Palmer  53 , Giovanni Sotgiu  54 , Giorgia Sulis  8 , Carlos A Torres-Duque  55 , Kazunori Umeki  56 , Mukund Uplekar  8 , Catharina van Weezenbeek  5 , Tuula Vasankari  57 , Robert J Vitillo  58 , Constantia Voniatis  59 , Maryse Wanlin  60 , Mario C Raviglione  8
Affiliations
Review

Towards tuberculosis elimination: an action framework for low-incidence countries

Knut Lönnroth et al. Eur Respir J. 2015 Apr.

Abstract

This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions.

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Conflict of interest statement

Conflict of interest: Disclosures can be found alongside the online version of this article at erj.ersjournals.com

Figures

FIGURE 1
FIGURE 1
Four dimensions of tuberculosis (TB) elimination in low-incidence countries.
FIGURE 2
FIGURE 2
Observed versus required annual rate of change in tuberculosis (TB) incidence to reach TB elimination (less than one case per million) by 2035 in 33 low-incidence countries.
FIGURE 3
FIGURE 3
Observed versus required annual rate of change in tuberculosis (TB) incidence to reach TB elimination (less than one case per million) by 2050 in 33 low-incidence countries.
FIGURE 4
FIGURE 4
Tuberculosis (TB) incidence rate in foreign-born and non-foreign-born populations, and proportion of TB cases that are foreign born in selected low-incidence countries, from 2012 data. The inserted numbers are the incidence rates per million in non-foreign-born populations.
FIGURE 5
FIGURE 5
Projected tuberculosis (TB) incidence rates in 33 low-incidence countries in 2035 assuming a decline of 90% between 2015 and 2035. The defined pre-elimination and elimination levels are shown.
See this image and copyright information in PMC

Comment in

References

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