Global tuberculosis control: lessons learnt and future prospects

• Published in: Nature reviews. Microbiology 2012-06, Vol.10 (6), p.407-416
• Main Authors: Lienhardt, Christian, Glaziou, Philippe, Uplekar, Mukund, Lönnroth, Knut, Getahun, Haileyesus, Raviglione, Mario
• Format: Article
• Language: English
• Subjects: 631/326/41/1762; 692/699/255/1856; 692/699/255/1901; Acquired immune deficiency syndrome; AIDS; Analysis; Antitubercular Agents - administration & dosage; Antitubercular Agents - pharmacology; Bacillus; Biomedical and Life Sciences; Communicable Disease Control - methods; Communicable Diseases, Emerging - epidemiology; Communicable Diseases, Emerging - prevention & control; Control; Drug resistance; Drug Resistance, Microbial; Drug therapy; Drug Therapy - methods; Global Health; HIV Infections - complications; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Immunization; Infectious Diseases; Life Sciences; Medical Microbiology; Medical policy; Microbiology; Mortality; Mycobacterium; Pandemics; Parasitology; Public health; review-article; Tuberculosis; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis - prevention & control; Virology; Wellness programs
• ISSN: 1740-1526; 1740-1534
• DOI: 10.1038/nrmicro2797

Key Points Improvements in socioeconomic conditions contributed thoroughly to the decline in tuberculosis (TB) incidence and mortality in most industrialized countries in the twentieth century. The discovery of effective tools to combat the TB epidemics in the early twentieth century (sputum smear microscopy, Mycobacterium bovis bacillus Calmette–Guérin vaccine and the first anti-TB drugs) raised high hopes for worldwide control in the second half of the century. However, in the 1970s interest in TB declined for about two decades. Owing to the emergence of the HIV/AIDS pandemic and the reports of anti-TB drug resistance, TB returned to the global public health agenda in the early 1990s. To address this, in 1991 the 44th World Health Assembly adopted a resolution recognizing TB as a major public health problem and in 1995 promoted DOTS (directly observed therapy, short course) as its solution. To improve TB control further and address the specific challenges of TB–HIV coinfection and multidrug-resistant TB (MDR-TB), in 2006, the WHO launched the Stop TB Strategy. This strategy builds on the expansion of high-quality DOTS, emphasizing the need to reach out to poor and vulnerable populations and fostering private sector and community involvement in TB care and control. As a result of worldwide efforts, 46 million patients with TB were successfully treated between 1995 and 2010, and up to 7 million lives were saved, including 2 million women and children. Global mortality rates fell by 40% between 1990 and 2010, and the international target of 50% mortality reduction by 2015 may be achieved if the current rate of decline is sustained. In 2010, there were 5.8 million official notifications of TB cases worldwide, up from 3.4 million in 1995, and there were an estimated 8.8 million incident cases (range, 8.5 million–9.2 million) of TB globally. The emergence of TB–HIV coinfection and of anti-TB drug resistance showed the limits of the current control tools, pointing at the need for wider research and development efforts for optimal diagnosis, prevention and treatment of all forms of TB in people of all ages. The fight against TB is becoming more and more multi-faceted and has to be carried out on many fronts. As attention is gradually shifting towards the aspiration of TB elimination, actions are required on four distinct and simultaneous fronts to achieve this ambitious goal: securing the core TB control functions; health system support; investing in research; a