||Mario C. Raviglione
||1Stop TB Department, World Health Organization, Geneva, Switzerland
||The global burden of tuberculosis (TB), a disease of poverty which impedes development and the control of which is a public good, is tremendous. WHO estimates that in 2004, 8.9 million new cases occurred worldwide and that 1.7 million patients died of TB, the vast majority of whom in the developing world. The highest incidence rates per capita were in Sub-Saharan Africa, although the highest numbers of cases were in Asia. However, TB does not spare any country in the world. The co-epidemic of HIV-associated TB, compounded by the scarcity of health services, is the main cause of the ever increasing numbers of cases in Africa, causing more than 500,000 deaths per year. In Eastern Europe and in China, the prevalence of multi-drug resistant TB (MDR-TB) is at its peak worldwide, with up to 14% of new cases. Overall, the incidence of TB is growing at 1% per year, largely due to the growth of cases in Africa. This burden has a severe economic impact, both at micro and macro levels in developing countries.
||The international community, driven by the Stop TB Partnership housed by WHO, has established clear targets for TB control, including those part of Goal 6 of the Millennium Development Goals (MDG). To achieve the ultimate target of reversing the incidence of TB by 2015, WHO has recently started to promote the new Stop TB Strategy, built around the cost-effective DOTS approach widely used over the last decade. Such new Strategy consists of six components: (i) pursue highquality DOTS expansion and enhancement; (ii) address TB/HIV, MDR-TB and other challenges; (iii) contribute to health system strengthening; (iv) engage all care providers; (v) empower people with TB and communities; (vi) enable and promote research.
|Conclusion (max 400 words):
||The Strategy underpins the Global Plan to Stop TB 2006-2015 launched in early 2006. Such plan was established on the basis of epidemiological projections conducive to the MDG target achievements and will cost 56 billion US$ (47 billion for implementation of the new Stop TB Strategy in all countries and 9 billion for research and development of new tools), of which 25 are potentially available based on current pledges and expected country commitments. Therefore, a gap of 31 billion US$ needs to be filled with both domestic and external resources. A fully implemented Global Plan will treat 50 million TB patients and save 14 million extra lives in the next decade.