par Migliori, Giovanni Battista;Lonnroth, Knut;Abubakar, Ibrahim;D'Ambrosio, Lia;De Vries, Gérard;Diel, Roland;Douglas, Paul;Falzon, Dennis;Gaudreau, Marc-André;Goletti, Delia;Gonzalez, Ochoa Edilberto;LoBue, Philip;Matteelli, Alberto;Njoo, Howard;Solovic, Ivan;Story, Alistair;Tayeb, Tamara;Van der Werf, Marieke;Weil, Diana;Zellweger, Jean-Pierre;Aziz, Mohammed Abdul M.;Lawati, Mohamed;Aliberti, Stefano;Arrazola de Onate, Wouter;Barreira, Draurio;Bhatia, Vineet;Blasi, Francesco;Bloom, Amy;Bruchfeld, Judith;Castelli, Francesco;Centis, Rosella;Chemtob, Daniel;Cirillo, Daniela;Colorado, Alberto;Dadu, Andrei;Dahle, Ulf;De Paoli, Laura;Dias, Hannah;Duarte, Raquel;Fattorini, Lanfranco;Gaga, Mina;Getahun, Haileyesus;Glaziou, Philippe;Goduadze, Lasha;Del Granado, Mirtha;Haas, Walter;Jarvinen, Asko;Kwon, Geun-Yong;Mosca, Davide;Nahid, Payam;Nishikiori, Nobuyuki;Noguer, Isabel;O'Donnell, Joan;Pace-Asciak, Analita;Pompa, Maria;Popescu, Gilda;Cordeiro, Carlos Robalo;Ronning, Karin;Ruhwald, Morten;Sculier, Jean-Paul ;Simunovic, Aleksandar;Smith-Palmer, Alison;Sotgiu, Giovanni;Sulis, Giorgia;Torres-Duque, Carlos;Umeki, Kazunori;Uplekar, Mukund;Van Weezenbeek, Catharina;Vazankari, Tuula;Vilillo, Robert;Voniatis, Constantia;Wanlin, Maryse;Raviglione, Mario
Référence The European respiratory journal, 45, page (928-952)
Publication Publié, 2015-03
Référence The European respiratory journal, 45, page (928-952)
Publication Publié, 2015-03
Article révisé par les pairs
Résumé : | This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions. |