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End TB Strategy

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 MDG target reached but TB not eliminated by 2050. Current rate of decline -2%/yr. China, Cambodia -4%/yr.

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End TB Strategy

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  1. End TB Strategy

  2. 1995

  3. HCW with cough since January. Seen at government clinic thrice with no sputum/CXR. Diagnosed TB in May only

  4. Full implementation of Global Plan: 2015 MDG target reached but TB not eliminated by 2050 Current rate of decline -2%/yr China, Cambodia-4%/yr W Europe after WWII -10%/yr Elimination target:<1 / million / yr-20%/yr

  5. Projected acceleration of TB incidence decline to target levels Current global trend: -2%/year Average -10%/year Optimize current tools, pursue universal health coverage and social protection Introduce new vaccine, new prophylaxis -5%/year Average -17%/year

  6. A WORLD FREE OF TB • Zero deaths, disease and suffering due to TB • End the Global TB Epidemic DRAFT Post-2015 TB Strategy at a glance • 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:

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. Mobile technology could be game-changer in fight against TB Stop TB partnership 28 May 2012

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