Are we on track to meet the target?
There has been substantial progress in reversing the spread of TB in Asia and Latin America and the Caribbean. This is offset however by an increase of the problem in sub-Saharan Africa and the Commonwealth of Independent States, where the number of TB cases (excluding people who are HIV positive) has increased between 1990 and 2005.

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Across the globe, the poor are at greater risk of TB. Studies in India have shown that the prevalence of TB is between two and four times higher among groups with low income and no schooling. Overcrowded conditions, poor nutrition and inadequate sanitation increase the probability of being
infected and developing active TB. Once they are ill, those who have limited access to health services are less likely to be diagnosed and treated for TB. The greater the numbers of people with active TB in a community, the more likely others are to become infected. This becomes a vicious circle in poor communities where TB flourishes. Over 90% of TB cases and 90% of deaths from TB occur in developing countries.

A key challenge for TB control today is finding those people who have limited access to effective TB treatment and curing them. Expanding innovative approaches such as linking the public and private sectors in the treatment and referral of such cases will be critical in reducing TB deaths among the poor.

The Impact Of Tb On Women And Children

TB is a leading cause of death among women of reproductive age. One of the reasons for this is that women are less likely than men to be tested and treated for TB. In addition, as greater numbers of women become infected with HIV, more are also becoming sick with TB. Over 250 000 children die every year of TB. Children are particularly vulnerable to TB infection because of frequent household contact. Children also suffer when their parents are infected. Every year in India alone, more than 300 000 children leave school on account of their parents’ TB.

The Socioeconomic Impact

Because TB typically affects the most productive and economically active segments of the population, the impact of illness on communities and households is very high. TB costs borne by the patient often exceed costs to the health ministry.

The socioeconomic burden of TB is frequently discussed in terms of the direct and indirect costs to households. These costs are higher for TB than most other diseases due to the length of the treatment period (six to eight months). Direct costs include paying for visits to clinics, tests and drugs. In addition, TB imposes high non-medical costs, such as the cost of additional nourishing foods and transport to and from clinics. The indirect costs of a long illness are also devastating for poor households. These include lost household income and production (such as food), adverse impacts on the health and education of family members (withdrawal of children from school) and the costs of sub-optimal land use.

• More than 75% of TB-related disease and death occurs among people between the ages of 15 to 54, the most economically active segment of the population.
  
  
• TB is estimated to deplete the incomes of the world's poorest communities by a total of US$ 12billion per year.
  
  
• The potential cost of lost productivity due to TB is in the order of 4 to 7% of GDP.
  
  
• The average TB patient loses three to four months of work time as a result of being sick; loss of household earnings ranges from 30 to 100%.
  
  
• Mean household spending on TB amounts to 8- 20% of the annual household income, varying by region.

In developing countries with few government safety nets, diseases like TB have a devastating impact on poor households which must resort to various coping strategies. Some of these strategies include reducing the quality and quantity of food in order to save money, selling assets, taking out loans and withdrawing children from school. Many of these strategies undermine the household’s long-term sustainability and ability to survive future shocks.

The Stop TB Partnership Secretariat is pleased to use this website as a tool to update its partners on its progress. All questions or suggestions related to the overall Global Plan can be emailed to globalplan@stoptb.org

Meeting of the Steering Committee for the Global Plan to Stop TB (2006-2015)
2 May 2005 - Addis Ababa, Ethiopia

The Coordinating Board has established a Steering Committee that provided useful guidance concerning the finalization of the 7 Working Groups (WG) Plans and the overall Global Plan. The Steering Committee reviewed each draft WG strategic plan and regional scenario; considered issues relating to the overall Plan, including the Plan’s vision, timetable, and processes; and agreed the next steps in developing the Plan. The Stop TB Coordinating Board at its meeting session on 4 May 2005 noted the Steering Committee’s decisions and considered its recommendations. (Point 5 - Part 2 of report below).

Finalised WG plans are due by the end of May 2005. In addition to consultation through the WGs, the Secretariat will organise an extensive review process in August-September 2005.

The Stop TB Coordinating Board endorsed the proposal of the World Economic Forum to launch the Global Plan during its Annual Meeting at Davos from 25-29 January 2006.

The report of the meeting can be downloaded from here.

The 7 draft WG Strategic Plans are as follows:

DOTS Expansion
DOTS-Plus
TB/HIV
New Diagnostics
New Drugs
New Vaccines
Advocacy, Communications and Social Mobilization

The table below provides a summary timetable for producing the Global Plan. A more detailed timetable is attached at Annex 2 of the Steering Committee meeting report.

Update on Global Plan to Stop TB 2006-2015


The Stop TB Partnership secretariat is coordinating the development of the Second Global Plan to Stop TB (2006-2015), under the guidance of the Steering Committee.* The Plan represents a roadmap for TB control over the next decade (2006-2015), in working towards the goal to eliminate TB as a global public health problem by 2050. Work started in May 2004 with building consensus among Stop TB partners on the outline of the Plan. The Plan will set out the action needed to reach the 2015 global targets for TB control, which are part of the United Nations (UN) Millennium Development Goals (MDGs). The global target is to halve TB prevalence and deaths by 2015 in comparison with 1990.

The development of a strategic plan (2006-2015) by each Working Group (WG) is crucial to the successful development and subsequent implementation of the Global Plan. The WGs have much to gain from the successful development of a global plan with wide support. At its meeting in Beijing in October 2004, the Coordinating Board requested each WG to develop its own strategic plan (2006-2015) in contribution to the overall Global Plan. The WG chairpersons and secretaries met in Beijing on 16 October 2004 straight after the Coordinating Board meeting to discuss the planning process for the WGs' contributions to the Global Plan. For each WG this involves planning the activities (ultimately with timelines and milestones) necessary to contribute to achieving the 2015 global TB control targets, with the accompanying costs.

The initial step in the planning process is to construct possible scenarios which consider how the activities of the seven WGs could, separately and together, contribute to reaching the targets in 2015. It is necessary to consider how the regions individually and the world overall can reach the 2015 global TB control targets. This work on epidemiological and costing projections will provide each WG with the basis for developing its strategic workplan in contribution to achieving the 2015 global targets. This planning process requires close interaction between the representatives of the seven WGs and the team assessing the epidemiological impact of the currently available and new tools.

At a planning workshop in Montreux, Switzerland (28 February to 4 March 2005), WG focal points (identified by each WG chairpersons and secretary) and the team assessing epidemiological impact will present and refine scenarios representing how the activities of each WG could contribute to global TB control. Developing the scenarios will build on work already done by some WGs in modelling the expected impact of their activities.

The Steering Committee will meet in April 2005 to review progress in developing the WGs' strategic plans in contribution to the Global Plan. The Coordinating Board's target date for the Global Plan's launch is the end of 2005. Successful development and implementation of the WG strategic plans depends on the involvement of a wide range of members of each WG. Table 1 shows the chairpersons and secretaries of the seven WGs who you should contact to indicate your interest. Please contact Dermot Maher (maherd@who.ch) regarding the overall Global Plan.

*Olusoji Adeyi (USA), Faruque Ahmed (Bangladesh), Nils Billo (France), Jaap Broekmans (Netherlands), Ken Castro (USA), Marcos Espinal (Switzerland), Maria Freire (USA), Phil Hopewell (USA), PR Narayanan (India), Francis Omaswa (Uganda), Mario Raviglione (Switzerland), Karam Shah (Pakistan), Roberto Tapia (Mexico), Irene Koek (USA), Edugie Abebe (Nigeria)

The Plan sets out actions for life - actions towards a world free of TB

PART I: Strategic Directions

Achievements in 2000 - 2005 and Challenges for 2006 - 2015
This section provides a brief description of the Partnership's structure and function, outlines the main achievements in global TB control since 2000, describes the current TB situation today, and sets out the challenges that lie ahead.

Achieving the Targets: What Needs to be Done
In setting out the main strategic directions to achieve global targets for TB control, this section indicates the following:

• the Partnership's vision, mission, and targets
• the Partnership's strategic directions and objectives
• the ways in which wider and wiser use may be made of existing strategies for TB control
• strategies to address the challenges posed by emerging threats such as MDR-TB and HIV
• the importance of operational research
• the ways in which new TB diagnostic tests, drugs, and vaccines will be developed and adopted
• the importance of technical cooperation in support of the implementation of effective TB control interventions
• the main approaches to monitoring and evaluation

Key Cross-Cutting Issues: Strengthening Health Systems, TB and Poverty, TB in Children, and TB and Gender

As the Partnership’s working groups take forward their individual strategic plans for 2006 - 2015, they will work within the overall holistic vision of the Global Plan to Stop TB. To do this, the Working Groups have to work together effectively and efficiently, and to take a common approach to key cross-cutting issues. This section addresses four such issues important to the Global Plan: health system strengthening, poverty, TB in children, and TB and gender.

Summary of Planned Achievements, Resource Needs and Impact
This section summarizes:

• what would be achieved if the Plan is fully implemented
• the resource needs to enable full implementation of the Plan
• the expected impact of full implementation of the Plan on the TB epidemic

PART II:GLOBAL & REGIONAL SCENARIOS FOR TB
CONTROL 2006 - 2015


PART III:PARTNERSHIP ACTION TO ACHIEVE GOALS
The entire details of The Global Plan to Stop TB 2006 – 2015 can be read on the link mentioned below.
http://www.stoptb.org/globalplan/plan_p1main.asp?p=1

During 2000, a standard data collection form was sent to 211 countries via WHO Regional Offices. The form has three sections which request information about: policy and practice in TB control; the number and types of TB cases notified in 1999; and the outcomes of treatment and retreatment (DOTS areas only) for smear-positive or culture-positive (mainly Europe) cases registered in 1998.

The main findings were:

1. There were an estimated 8.4 million new tuberculosis cases in 1999, up from 8.0 million in 1997; the rise is due largely to a 20% increase in incidence in African countries most affected by the epidemic of HIV/AIDS. If present trends continue, 10.2 million new cases are expected in 2005, and Africa will have more cases than any other WHO Region.
2. Following a decade of successful control, and the consequent reduction in incidence, Peru fell to bottom place in the league of high-burden countries in 1999. It was eliminated from TB80 during 2000.
3. The number of countries implementing the DOTS strategy (at least in part) increased by 8 during 1999, bringing the total to 127 (out of 211).
4. The fraction of the world's population that had access, in principle, to DOTS increased slightly from 43% in 1998 to 45% in 1999.
5. Roughly one quarter (23%) of estimated new smear-positive cases were reported to DOTS programmes in 1999, as compared with 22% in 1998; this is consistent with the average increment of about 120 000 cases in each year since 1994.
6. If this trend is maintained, the target of 70% case detection under DOTS will not be reached until 2013; to get to the target by 2005, DOTS programmes must collectively recruit at least 300 000 additional smear-positive cases each year.
7. There was an insignificant increase between 1998 and 1999 in the total number of smear positive cases reported to WHO; about 1.4 million cases were reported in both years (41% of the estimated total).
8. Almost all (92%) of the progress in DOTS expansion, as judged by smear-positive case notifications, was made in just 5 countries; 65% of these additional cases were found in 2 countries, India and South Africa.
9. Treatment success of new smear-positive patients has remained high under DOTS, and exceeded 80% in the most recent cohort (1998).
10. Against expectation, the cure rate measured by sputum smear conversion in 12 European countries was not consistently higher than the cure rate measured by culture conversion; in order to explain this result, treatment outcomes must be examined for patients individually, rather than in aggregate.
11. In 1999, Peru and Viet Nam were still the only high-burden countries to have exceeded both WHO targets of 70% case detection and 85% treatment success. However, several other TB80 countries are within reach: they include Brazil, Cambodia, Kenya, the Philippines, South Africa and Tanzania.
12. A number of smaller countries appear to have declining TB incidence rates that are linked to high rates of case detection and cure; these include Cuba, Lebanon, the Maldives, Nicaragua, Oman and Uruguay.
13. During the preparation of this report, China announced preliminary results of a nationwide survey suggesting a comparatively large reduction in TB prevalence in 13 provinces that have participated in the IEDC TB control project since 1990.

Estimated Incidence rates of HIV-positiveTB, 1999

Conclusion
Progress in global TB control has remained steady, but slow. Despite large numbers of patients recruited in India and South Africa during 1999, DOTS implementation overall was no faster than in previous years. DOTS programmes worldwide will have to increase the number of additional patients enrolled annually by a factor of 2.5 in order to meet 2005 targets. Following the impact of short-course chemotherapy in Peru (reduced incidence) and China (reduced prevalence), detailed epidemiological analyses are needed to find out whether other control programmes with high rates of case detection and cure have also succeeded in reducing TB burden.

Copies of Global Tuberculosis Control are available from:
Communicable Diseases
World Health Organization
20 Avenue Appia
CH-1211 Geneva 27
Switzerland

Table 1. Categorization of countries
Category Definition

0	Countries not reporting to WHO.
1	Countries not implementing the DOTS strategy and having an estimated incidence rate of 10 or more cases per 100 000 population.
2	Countries implementing the DOTS strategy in less than 10% of the total population (pilot phase).
3	Countries implementing the DOTS strategy in 10 to 90% of the total population (expansion phase).
4	Countries implementing the DOTS strategy in over 90% of the total population (routine implementation).
5	Countries not implementing the DOTS strategy but having an estimated incidence rate of less than 10 cases per 100 000 population (low incidence).

Results
Global and regional progress in TB control

Countries reporting to WHO
By 22 January 2001, 171 (81%) of 211 countries reported case notifications for 1999 and/or treatment outcomes for patients registered in 1998, 18 fewer than last year. We received reports from all high-burden countries except Mozambique, all countries with more than 30 million people except Canada, and all other countries with more than 10 million people except Yemen, Madagascar and Niger (Tables 5a and 5b).

Table 5a. List of countries implementing DOTS, 1999

Table 5b. List of countries not implementing DOTS or not reporting to WHO, 1999

By the end of 1999, 82% of the world's population was living in countries that had adopted DOTS (categories 2-4). Reported DOTS population coverage was greatest in the American (62%), Western Pacific (57%) and African Regions (55%) (Figure 6). Table 6 tabulates DOTS coverage for each high-burden country, and for the whole world, from 1995 to 1999. Seventeen countries implemented DOTS for the first time in 1999 (Table 5a). Three had achieved limited coverage (< 10%, Category 2), DPR Korea, Lithuania and Tajikistan. Five achieved moderate coverage (10-90%, Category 3), including China Hong Kong SAR, Costa Rica, Mauritania and Saudi Arabia. The remaining nine reached high coverage (> 90%), including Libya and Tunisia. Among the four countries that moved up to category 3 in 1999 were Haiti, India and Poland. Bolivia, Iran and Kazakhstan were the biggest of six countries that reached full coverage (category 4). Sixteen countries that had implemented DOTS by 1998 failed to provide data for 1999, including Mozambique, Madagascar and Niger (Table 5b).