The Americas can end tuberculosis by 2030
by the Pan-American Health Organization
The Region of the Americas can reach the goal of ending tuberculosis (TB) in the next decade if countries are able to accelerate progress achieved so far, reducing even more the number of deaths and new cases per year, warns the Pan American Health Organization (PAHO), regional office for the Americas of the World Health Organization (WHO).
Within the framework of World TB Day, which is celebrated on 24 March, PAHO is urging countries to take the necessary steps to close the gaps in the care of people with tuberculosis, ensure early diagnosis with available new technologies, and work with the most vulnerable populations. The Organization is also calling on sustainable financing for national tuberculosis programs so that countries can reach the goal of ending tuberculosis by 2030.
“While the Region of the Americas has managed to reduce new cases and deaths from tuberculosis in the last 15 years, ending this disease is only possible if progress is accelerated,” said Dr. Marcos Espinal, Director of the Department of Communicable Diseases and Environmental Determinants of Health at PAHO. “Countries should expand access to diagnosis with rapid molecular tests and timely quality treatment for those who need it. They must also work with people, communities and other sectors on the social determinants that facilitate transmission of this disease.”
In 2017, WHO estimated 282,000 new cases of tuberculosis in the Americas, 11% of which were in people living with HIV. In all, 87% of cases were concentrated in 10 countries, with Brazil, Colombia, Haiti, Mexico and Peru reporting two thirds of the total cases and deaths. According to a PAHO report published in September 2018, an estimated 24,000 people died in 2017 from tuberculosis in the Region, and 6,000 of them were coinfected with HIV.
“It’s time!” campaign
The slogan for this year’s World TB Day campaign is “It’s time for Action. End TB”. This serves as a reminder that fulfilling the commitments made by heads of state in September last year at the first High Level Meeting of the United Nations’ General Assembly on tuberculosis, must be accelerated. At the meeting, world leaders agreed to implement bold goals and urgent measures to end the disease.
Ending the global tuberculosis epidemic is one of the targets of the Sustainable Development Goals (SDGs). WHO’s End TB Strategy, adopted by the World Health Assembly in 2014, aims to reduce deaths from TB by 90% and the incidence of the disease (number of new cases each year) by 80% by 2030, compared to 2015 levels. Three intermediate goals have also been established for 2020: reduce TB deaths by 35%, reduce the TB incidence rate by 20%, and ensure that families affected by TB do not face catastrophic costs for treating the disease.
Challenges to ending TB in the Americas
The persistence of tuberculosis is due, to a great extent, to the social and economic inequalities that remain in the Region. Since 2015, deaths fell by 2.5% on average per year and new cases dropped by 1.6%, but according to PAHO’s September 2018 report, they need to fall at a rate of 12% and 8% per year, respectively, to achieve the intermediate targets for 2020 and continue to decline until 2030.
In the Americas, more than 50,000 people – almost half of them under the age of 15, do not know they have the disease and have not been treated. The use of rapid molecular diagnostic tests, a new tool that could help closed the gap, was used in just 13% of diagnosed cases, up slightly from 9% in 2016.
TB treatment has saved thousands of lives. However, in the last five years 75% of patients has a successful treatment, which is below the 90% target set for 2030. It is therefore recommended that countries improve patient monitoring to ensure treatment adherence (8.6% abandon treatment), among other issues.
Multidrug-resistant tuberculosis also represents a serious threat, with an estimated 11,000 people in the Region currently affected by this form of the disease. The treatment success rate in these cases falls to 56%.
To accelerate progress towards TB elimination, particularly in countries with the greatest disease burden, PAHO recommends: accelerating the implementation of rapid molecular diagnostic tests; promoting tracing contacts of people with TB, particularly those under the age of 15; accelerating the implementation of new medicines; securing national funding rather than depending on external funds; working with vulnerable populations that require a special approach; and having the active participation of civil society.
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