Transcript End TB Strategy - pulmonology kkm

End TB Strategy
1995
HCW with cough since
January. Seen at
government clinic thrice
with no sputum/CXR.
Diagnosed TB in May only
Full implementation of Global Plan: 2015 MDG
target reached but TB not eliminated by 2050
Current rate of
decline -2%/yr
China, Cambodia
-4%/yr
W Europe after WWII 10%/yr
Elimination target:<1 / million / yr
-20%/yr
Projected acceleration of TB incidence decline
to target levels
Current global trend: -2%/year
Average
-10%/year
Optimize current tools,
pursue universal health
coverage and social
protection
Introduce new vaccine,
new prophylaxis
-5%/year
Average
-17%/year
DRAFT Post-2015 TB Strategy at a glance
VISION:

A WORLD FREE OF TB
Zero deaths, disease and suffering due to TB
GOAL:

End the Global TB Epidemic
TARGETS FOR 2035:


95% reduction in TB deaths (compared with 2015)
90% reduction in TB incidence rate (<10/100,000)
MILESTONES FOR 2025:



75% reduction in TB deaths (compared with 2015)
50% reduction in TB incidence rate (< than 55/100,000)
No affected families face catastrophic costs due to TB
Pillar 1: Innovative TB care
•
Rapid diagnosis of TB including universal drug
susceptibility testing;systematic screening of contacts
and high-risk groups
•
Treatment of all forms of TB including drug-resistant
TB, with patient support
•
Collaborative TB/HIV activities and management of
co- morbidities
•
Preventive treatment for high-risk groups and
vaccination of children
Pillar 2: Bold Policies and Supportive
Systems
•
Government stewardship, commitment, and adequate
resources for TB care and control with monitoring and
evaluation
•
Engagement of communities, civil society organizations,
and all public and private care providers
•
Regulatory framework for vital registration, case
notification, drug quality and rational use, and infection
control
•
Universal Health Coverage, social protection and other
measures to address social determinants of TB
Pillar 3: Intensified Research and Innovation
•
Discovery, development and rapid uptake of new
diagnostics, drugs and vaccines
•
Operational research to optimize implementation and
adopt innovations
Tools required for eradication in our lifetime:
A potent regimen for treatment


Assessment of fluoroquinolone trials in early 2014
Three trials:
 OFLOTUB/Gatifloxacin for TB Phase III trial: gatifloxacin substituted for ethambutol – 4 months Rx results expected second half 2013
 ReMox: moxifloxacin substituted for ethambutol or isoniazid – 4 months Rx - results expected early
2014
 Rifaquin trial: moxifloxacin substituted for ethambutol (intensive phase), associated with
rifapentine once weekly in continuation phase – presentation at CROI 2013. 4-month arm did not
work

NC-001 regimen: PA-824, pyrazinamide, moxifloxacin
Tools required for eradication in our lifetime:
Vaccines
Mass vaccination with a potent vaccine:
–
pre-exposure:
would prevent infection to occur, and therefore disease,
but impact would take a long time to appear
–
post-exposure:
would prevent “reactivation”, and would have impact on
transmission as new cases will not emerge any longer out of
the pool of already infected. However, it would not prevent
new infection
Mobile technology could be game-changer in fight against TB
Stop TB partnership
28 May 2012