Towards tuberculosis elimination: an action framework for low-incidence countries
Authors: Lönnroth Knut , Migliori Giovanni Battista , Abubakar Ibrahim , D'Ambrosio Lia , de Vries Gerard , Diel Roland , Douglas Paul , Falzon Dennis , Gaudreau Marc-Andre , Goletti Delia , González Ochoa Edilberto R. , LoBue Philip , Matteelli Alberto , Njoo Howard , Solovic Ivan , Story Alistair , Tayeb Tamara , van der Werf Marieke J. , Weil Diana , Zellweger Jean-Pierre , Abdel Aziz Mohamed , Al Lawati Mohamed R.M. , Aliberti Stefano , Arrazola de Oñate Wouter , Barreira Draurio , Bhatia Vineet , Blasi Francesco , Bloom Amy , Bruchfeld Judith , Castelli Francesco , Centis Rosella , Chemtob Daniel , Cirillo Daniela M. , Colorado Alberto , Dadu Andrei , Dahle Ulf R. , De Paoli Laura , Dias Hannah M. , Duarte Raquel , Fattorini Lanfranco , Gaga Mina , Getahun Haileyesus , Glaziou Philippe , Goguadze Lasha , del Granado Mirtha , Haas Walter , Järvinen Asko , Kwon Geun-Yong , Mosca Davide , Nahid Payam , Nishikiori Nobuyuki , Noguer Isabel , O'Donnell Joan , Pace-Asciak Analita , Pompa Maria G. , Popescu Gilda G. , Robalo Cordeiro Carlos , Rønning Karin , Ruhwald Morten , Sculier Jean-Paul , Simunović Aleksandar , Smith-Palmer Alison , Sotgiu Giovanni , Sulis Giorgia , Torres-Duque Carlos A. , Umeki Kazunori , Uplekar Mukund , van Weezenbeek Catharina , Vasankari Tuula , Vitillo Robert J. , Voniatis Constantia , Wanlin Maryse , Raviglione Mario C. 
Published: March 2015

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.