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

This paper describes an action framework for countries with low tuberculosis (TB) incidence (&lt;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” (&lt;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.