FOREWORD - who.int

1 FOREWORD . We stand at a crossroads as the United Nations Member States in 2014 places patients and move from the 2015 Millennium Development communities at the heart of the response. Here Goals (MDGs) to the Sustainable Development is an introduction to the End TB Strategy. Goals (SDGs) for 2030. We are thankful for the deep engagement Integral to this transition, the world community of a wide array of partners in developing the is launching a dramatically accelerated fight strategy and targets: ministries of health and against tuberculosis (TB) and for those most other governmental authorities, civil society affected by it: the poorest, most vulnerable, representatives, development and public socially marginalized and inequitably served. health experts, and researchers. We are all TB is a public health scourge, a health security committed to support the robust roll-out of the threat and a development challenge.

2 The World Strategy. The time to gear up and to act is now. Health Organization's new and holistic strategy To end TB, we depend on your engagement. approved by the World Health Assembly of 194. Dr Mario Raviglione Director, Global TB Programme World Health Organization 1. TUBERCULOSIS. TB is a top killer worldwide, ranking alongside HIV/AIDS. TB places its heaviest burden on the world's most poor and vulnerable, aggravating existing inequalities. Due to TB, people face costs or suffer income loss equivalent on average to more than 50% of their income. BURDEN. million million million people 480 000 people people fell ill men, women and living with HIV developed MDR-TB. with TB in 2014 children died developed TB, (multidrug-resistant TB). from TB in 2014 with million in 2014, with 190 000.

3 Associated deaths in associated deaths 2014. 2. WHERE ARE. WE TODAY? PROGRESS. 43 million 47% decline in TB HIV-related TB Fragile progress in lives saved mortality rate deaths down MDR-TB. between 2000 and and 42% decline in by 32% in the last Treatment for MDR- 2014 through effective TB prevalence rate decade TB has increased TB diagnosis and since 1990 with almost all cases treatment detected in 2014 started treatment CHALLENGES. US$ billion million TB/HIV response MDR-TB remains funding gap people with TB needs acceleration a public health crisis per year for are missed Antiretroviral treatment, Only one in four MDR-TB. implementation of existing by health systems treatment of latent TB cases detected and one in TB interventions. An every year and infection and other key two cases cured additional gap of US$ therefore may not get interventions still need billion exists for research adequate care they further scale-up need 3.

4 A NEW. Vision GOAL. Everyone with TB should have access to the innovative tools and services they need for rapid diagnosis, treatment and care. This is a matter of social justice, fundamental to our goal of universal health coverage. Given the prevalence of drug-resistant tuberculosis, ensuring high- quality and complete care will also benefit global health security. I call for intensified global solidarity and action to ensure the success of this transformative End TB Strategy.. Margaret Chan Director General World Health Organization 4. STRATEGY. A WORLD FREE OF TB. ZERO deaths, disease, and suffering due to TB. END THE GLOBAL TB EPIDEMIC. TARGETS. MILESTONES SDG* END TB. 2020 2025 2030 2035. Reduction in number of TB. deaths 35% 75% 90% 95%. compared with 2015 (%). Reduction in TB.

5 Incidence rate compared with 2015 (%). 20% 50% 80% 90%. TB-affected families facing catastrophic costs 0% 0% 0% 0%. due to TB (%). * The United Nations Sustainable Development Goals (SDGs) include ending the TB epidemic by 2030 under Goal 3. 5. REACHING THE TARGETS W. The Strategy: Provides a unified response to ending TB deaths, disease, and suffering. Builds on three strategic pillars underpinned by four key principles. THE END TB STRATEGY: PILLARS AND PRINCIPLES. PILLAR 1 PILLAR 2. Integrated, Bold policies patient- and supportive centered systems TB care and prevention Government stewardship and accountability, with monitorin Building a strong coalition with civil society and com Protecting and promoting human rights, ethics and Adaptation of the strategy and targets at country level, with g 6.

6 WITH THE END TB STRATEGY. PILLARS. Bring together critical interventions to ensure PILLAR 3 that all people with TB have Intensified equitable access to high-quality research and diagnosis, treatment, care and innovation prevention, without facing catastrophic expenditure or social repercussions. ng and evaluation PRINCIPLES. The success of the Strategy mmunities in driving down TB deaths and illness will depend on countries respecting the key d equity principles as they implement the interventions outlined in each pillar. global collaboration 7. This pillar puts patients at the heart of service PILLAR. INTEGRATED, PATIENT- CENTRED CARE AND. 1. delivery. PREVENTION. Focuses on early detection, treatment and prevention for all TB patients including children. Aims to ensure that all TB patients not only have equal, unhindered access to affordable services, but also engage in their care.

7 How pillar 1 works : Key components A. Early diagnosis B. Treatment of of TB including all people with TB. universal drug- including drug- susceptibility testing, resistant TB, and and systematic patient support screening of contacts and high-risk groups D. Preventive C. Collaborative TB/. treatment of persons HIV activities; and at high risk; and management of co- vaccination against morbidities TB. 8. PILLAR. BOLD POLICIES. AND SUPPORTIVE. 2 This pillar requires intense participation SYSTEMS across government, Strengthens health and social sector policies and communities and systems to prevent and end TB. Supports implementation of universal health private stakeholders. coverage, social protection, and strengthened regulatory frameworks. Addresses the social determinants of TB and tackles TB among vulnerable groups such as the very poor, people living with HIV, migrants, refugees and prisoners.

8 How pillar 2 works : Key components A. Political B. Engagement of commitment with communities, civil adequate resources society organizations, for TB care and and all public and prevention private care providers D. Social protection, C. Universal health poverty alleviation coverage policy, and and actions on other regulatory frameworks determinants of TB for case notification, vital registration, quality and rational use of medicines, and infection control 9. This pillar on research is critical to break PILLAR. INTENSIFIED. RESEARCH AND. 3. the trajectory of the INNOVATION. epidemic and reach Aims to intensify research from the development the global targets. of new tools to their adoption and effective roll- out in countries. Pursues operational research for the design, implementation, and scaling-up of innovations.

9 Calls for an urgent boost in research investments, so that new tools are developed, and made rapidly available and widely accessible in the next decade. How pillar 3 works : Key components A. Discovery, development B. Research to optimize and rapid uptake of new tools, implementation and impact;. interventions and strategies and promote innovations 10. ACTIONS TO IMPACT. Getting to the 2025 targets requires Moving forward to the 2035 targets effective use of existing tools to combat TB, requires the ensured availability of new complemented by universal health coverage tools from the research pipeline, in particular: and social protection to: Better diagnostics, including new point-of- Push down global TB incidence rates from care tests;. an annual decline of 2% in 2015 to 10% by Safer, easier and shorter treatment 2025.

10 Regimens;. Reduce the proportion of people with TB Safer and more effective treatment for who die from the disease from 15% in 2015 latent TB infection;. to 5% by 2025. Effective pre- and post-exposure vaccines. Desired decline in global TB incidence rates to reach the 2035 targets 100. Current global trend: 75. Optimize use of current & new tools -10%/year by 2025. Rate per 100,000/year emerging from pipeline, pursue universal health 50 coverage and social protection Introduce new tools: a vaccine, new drugs &. -5%/year treatment regimens for 25 treatment of active TB. disease and latent TB. infection, and a point-of- -17%/year care test 10. 2015 2020 2025 2030 2035. 11. The progress that has been made in combating TB has been hard won and must be intensified if we are to wipe out the TB epidemic.