Supporting progress towards the post-2015 targets and regional TB elimination. A statement of intent
from the 3rd Meeting of Asian TB Experts Community
The WHO is challenging all countries, both high and low-incidence, to dramatically intensify efforts to meetbold new goals of reducing the global TB deaths by 95% and incidence by 90% (<10 cases/100,000) by2035(1). This radical strategic change came from the recognition that the current strategy of passive casefinding and DOT is not sufficiently curbing the incidence of TB. The new strategy calls for a synergy ofinterventions for early case detection, systematic screening, and prevention of contacts and high-risk
groups such as those with HIV or immune depression, diabetics, health care workers, tobacco users andindividuals in congregate settings.
The available evidence suggests that screening, if performed according to evidence and targeting the rightpeople, may reduce suffering, death and all the downstream consequences of active TB. There ishowever, a need to balance potential benefits against the risks and costs of screening. The 2013
recommendations of the WHO on systematic screening for active TB states that, “indiscriminate mass
screening should be avoided while risk groups should be prioritized for screening based on carefulassessment of the local TB epidemiology, potential benefits and risks of harm of screening and alternativeinterventions to improve early TB detection” (8).
It is against this background that on August 16-17, 2014 , a group of Asian leaders from 14 countries,
national and international experts on tuberculosis (TB), diabetes, and rheumatology met in Macau, Chinato initiate discussion on the post-2015 WHO challenge of active case finding and prevention as a strategy
for accelerating TB elimination in Asia. The objectives of the meeting were to discuss the strategy andevidence of active case finding and prevention among high risk groups; review the current epidemiology
and practices of Asian countries regarding case finding; and to explore the most advanced approaches toinvestigate and treat contacts exposed to multi-drug resistant tuberculosis (MDR-TB), as well as screening
and prevention of populations at risk in high burden settings.
The meeting was sponsored and coordinated by STOP TB Japan and co-chaired by Dr. Toru Mori DirectorEmeritus, Research Institute of Tuberculosis (RIT), Japanese Anti-Tuberculosis Association (JATA) and Dr.
Erlina Burham, Head, Clinical Expert Team on MDR-TB and faculty of the Universitas Indonesia’s
Pulmonology and Respiratory Medicine Department.
The theme of the meeting was introduced by the keynote speaker, Dr. Nobu Nishikiori, Team leader Stop
TB and Leprosy Elimination, WPRO, who provided an overview on the target linked to the post-2015
strategy. Presentations followed by regional and international experts analyzing the current TB controlsituation and assessing the feasibility of potential interventions in the context of scaling up active casefinding and TB preventive treatment.
Pediatric, rheumatologist and diabetic experts all presented on the impact of TB in their field of expertise,clearly emphasizing the importance of active case finding, better TB control and screening in selecttargeted groups.

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Tel 03 5282 3010 Fax 03 5980 8267
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Although the heterogeneity of the region was widely recognized, an overarching consensus emerged on
the need to identify and target high risk populations within the context of country specific epidemiologicaland control settings. In particular, screening and active case finding interventions should become a matterof priority in those populations where the morbidity and mortality risk far exceeds that of the surrounding
general populations. There was unanimous agreement that without a scale up of these targeted active casefinding interventions, it would be unlikely that any substantial progress towards TB elimination would beachieved in the decades to come. Finally, it evinced from several country and expert presentations that due
consideration should now be given to expanding the role of preventive treatment as a programmaticintervention with harm-benefit and cost-effectiveness rationale taken into consideration under thedifferent settings.
This meeting was convened in the spirit of advancing TB control in Asia and represents the first concerted
regional reaction to the call for change in pace that the post-2015 strategy. Regional and country specificissues and approaches were discussed and debated in the spirit of reaching the highest ideals. Other
regions have recognized the need to initiate dialogue in this direction and have established forums andchannels for intense discussion on the value and need for solid TB elimination strategies (2, 4, 5,6).
Although an Asian region-wide consensus on the next steps requires further concerted action undernational and regional leadership, participants agreed on the intention to advance in the acceleration
towards elimination of TB through: Better understanding, targeting and implementation of active case finding interventions with the aim
to reach out to the most affected in order to maximize the impact on the TB epidemic;
 Considering and evaluating approaches for TB prevention as a strategy to eliminate TB in Asia andaccelerate burden decline; Tailoring approaches to the current epidemiological and TB control situation in countries while
recognizing the undeniable right of each individual to access a holistic spectrum of TB services including
TB prevention;
 Recognizing that concerted health infrastructure development, leadership, solidarity and action will berequired to shape the future of TB control in Asia.
Funding declaration: Funding for the meeting was provided to STOP TB Japan through an unrestrictededucational grant from QIAGEN No promotional activity took place in the context or associated with themeeting.

References
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