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 MDGtarget reached but TB not eliminated by 2050

Current rate of decline -2%/yr

W Europe after WWII -10%/yr

China, Cambodia-4%/yr

Elimination target:<1 / million / yr-20%/yr

Projected acceleration of TB incidence decline to target levels

Optimize current tools, pursue universal health

coverage and social protection

Introduce new vaccine, new prophylaxis

Average -10%/year

-5%/year

Current global trend: -2%/year

Average -17%/year

DRAFT Post-2015 TB Strategy at a glance

A WORLD FREE OF TB Zero deaths, disease and suffering due to TB

End the Global TB Epidemic

95% reduction in TB deaths (compared with 2015) 90% reduction in TB incidence rate (<10/100,000)

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

VISION:

GOAL:

TARGETS FOR 2035:

MILESTONES FOR 2025:

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

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

Tools required for eradication in our lifetime:A potent regimen for treatment

NC-001 regimen: PA-824, pyrazinamide, moxifloxacin

Mass vaccination with a potent vaccine:

– pre-exposure:

– post-exposure:

Tools required for eradication in our lifetime: Vaccines

would prevent infection to occur, and therefore disease,but impact would take a long time to appear

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 partnership28 May 2012