end tb strategy
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Here is a complete overview of the WHO End TB Strategy, drawn primarily from Park's Textbook of Preventive and Social Medicine and supplemented with current WHO data.
The WHO End TB Strategy
Background
The End TB Strategy was adopted by the World Health Assembly in May 2014 and included as a target within the health-related Sustainable Development Goal 3 (ending the TB epidemic). It is the successor to:
- DOTS Strategy (1994-2005) - established the basic framework: government commitment, passive case detection, standardized short-course chemotherapy, drug supply systems, and monitoring.
- Stop TB Strategy (2006-2015) - broadened the response to address HIV-associated TB, MDR-TB, engaged all care providers (public/private), and encouraged research investment.
The End TB Strategy represents a paradigm shift - recognizing that TB is not merely a biomedical problem but a disease of poverty, requiring a mix of health and social interventions.
Vision, Goal, Milestones and Targets
| Indicator | 2020 Milestone | 2025 Milestone | SDG 2030 Target | End TB 2035 Target |
|---|---|---|---|---|
| Reduction in TB deaths (vs. 2015) | 35% | 75% | 90% | 95% |
| Reduction in TB incidence rate (vs. 2015) | 20% (<85/100,000) | 50% (<55/100,000) | 80% (<20/100,000) | 90% (<10/100,000) |
| TB-affected families facing catastrophic costs | Zero | Zero | Zero | Zero |
- Vision: A world free of TB - zero deaths, zero disease, zero suffering due to TB.
- Goal: End the global tuberculosis epidemic (by 2035).
Four Barriers Identified
The strategy identifies four key barriers to progress:
- Weak health systems
- Underlying determinants of TB (poverty, undernutrition, migration, ageing population) and risk factors (diabetes, silicosis, smoking)
- Lack of effective tools
- Continuous unmet funding needs
Three Pillars and Ten Components
Pillar 1: Integrated, Patient-Centred Care and Prevention
- A. Early diagnosis of TB including universal drug-susceptibility testing, and systematic screening of contacts and high-risk groups
- B. Treatment of all people with TB including drug-resistant TB, and patient support
- C. Collaborative TB/HIV activities, and management of co-morbidities
- D. Preventive treatment of persons at high risk and vaccination against TB
Pillar 2: Bold Policies and Supportive Systems
- A. Political commitment with adequate resources for TB care and prevention
- B. Engagement of communities, civil society organizations, and public and private care providers
- C. Universal health coverage policy, and regulatory frameworks for case notification, vital registration, quality and rational use of medicines, and infection control
- D. Social protection, poverty alleviation, and actions on other determinants of TB
Pillar 3: Intensified Research and Innovation
- A. Discovery, development, and rapid uptake of new tools, interventions, and strategies
- B. Research to optimize implementation and impact, and promote innovations
Four Underlying Principles
- Government stewardship and accountability, with monitoring and evaluation
- Strong coalition with civil society organizations and communities
- Protection and promotion of human rights, ethics, and equity
- Adaptation of the strategy and targets at country level, with global collaboration
Global Plan 90-90-90 Targets
The Global Plan (linked to the End TB Strategy) sets 90-90-90 targets:
- Reach at least 90% of all people with TB (diagnose them)
- Reach at least 90% of key populations (the most vulnerable, underserved, at-risk)
- Achieve at least 90% treatment success for all people diagnosed with TB
Key Populations
Three groups are particularly prioritized:
| Group | Examples |
|---|---|
| Increased exposure (where they live/work) | Prisoners, sex workers, miners, healthcare workers, slum dwellers, contacts of TB patients |
| Limited access to quality TB services | Migrant workers, women in gender-disparate settings, children, refugees, homeless, indigenous groups |
| Increased biological/behavioral risk (immune compromise) | PLHIV, diabetics, those on immunosuppressive therapy, malnourished, tobacco/alcohol users, injecting drug users |
New Tools Required
Ending the TB epidemic requires breakthroughs in three areas:
- A point-of-care test for diagnosing infection and disease
- Shorter, better treatment regimens for disease and latent infection
- A pre- and post-exposure vaccine
Current Progress (as of 2024-2025)
The world is significantly off-track:
- TB incidence has only declined ~8.3% since 2015 (goal: 50% by 2025)
- TB deaths have only fallen ~23% since 2015 (goal: 75% by 2025)
- COVID-19 pandemic caused major setbacks to TB services in 2020-2021
TB remains the leading infectious cause of death worldwide, surpassing COVID-19 as of recent data.
- Park's Textbook of Preventive and Social Medicine, pp. 238-239
- WHO End TB Strategy (World Health Assembly, 2014)
- Global TB Report 2024 (WHO)
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