Operational research to strengthen tuberculosis control in the Americas

Abstract

Tuberculosis (TB) continues to be an important global health problem, despite significant progress since the declaration of TB as a global public health emergency by the World Health Organization (WHO) in 1993. Mortality has declined by 45% since then, with annual decreases of incidence and an estimated 37 million lives saved between 2000 and 2013. Countries have made a considerable effort to achieve the 2015 global targets related to TB within the context of the Millennium Development Goals (MDGs) and the Stop TB Strategy. In spite of this, an estimated 9 million people developed TB in 2013, of whom 360 000 cases were co-infected with HIV and 1.5 million died from the disease (1). In the Region of the Americas, great progress has been made since the implementation of the Directly Observed Treatment Short Course (DOTS) Strategy in the 1990’s, and then of its successor the Stop TB Strategy in 2006 (2). According to WHO estimates, TB incidence in the Region declined 48% from 1990 to 2013, while prevalence and mortality were reduced by 57% and 68% respectively during this period. This has allowed the Region as a whole to reach the MDG and linked targets before the 2015 dateline. Nevertheless, there are big differences among and within countries, and some of them might not even reach the targets. In 2013 WHO estimated that 285 200 individuals developed TB and 17 000 died from the disease in the Americas, 31 800 were co-infected with HIV, and 6 900 had multidrug resistant TB (MDR-TB). In that year, 77% of the TB cases were notified, leaving a gap of 65 000 patients not being detected. Most (68%) of the notified patients knew their HIV status, but only 50% of the MDR-TB cases were diagnosed. Results from the latest (2012) cohort analysis showed that 75% of new TB patients were successfully treated, falling short of the 85% target for 2015 (3)...