Emilio Dirlikov, PhD; Mario Raviglione, MD; Fabio Scano, MD
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Grant Support: Mr. Dirlikov's doctoral studies are supported by the Programme bourses d'excellence pour étudiants étrangers from the Fonds Québécois de la recherche sur la nature et les technologies (Dossier 136663). No additional external funding was provided for this research.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2210.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Requests for Single Reprints: Emilio Dirlikov, MA, Department of Anthropology, McGill University, 7th Floor, Leacock Building, 855 Sherbrooke Street West, Montreal, Quebec H3A-2T7 Canada; e-mail, email@example.com.
Current Author Addresses: Mr. Dirlikov: Department of Anthropology, McGill University, 7th Floor, Leacock Building, 855 Sherbrooke Street West, Montreal, Quebec H3A-2T7 Canada.
Dr. Raviglione: Global TB Programme, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
Dr. Scano: Disease Control, World Health Organization China Representative Office, 401 Dongwai Diplomatic Building, 23 Dongzhimenwai Dajie, Chaoyang District, Beijing 100600, PR China.
Author Contributions: Conception and design: E. Dirlikov, M. Raviglione, F. Scano.
Analysis and interpretation of the data: E. Dirlikov, M. Raviglione, F. Scano.
Drafting of the article: E. Dirlikov, F. Scano.
Critical revision of the article for important intellectual content: E. Dirlikov, M. Raviglione, F. Scano.
Final approval of the article: E. Dirlikov, M. Raviglione, F. Scano.
Administrative, technical, or logistic support: E. Dirlikov, M. Raviglione, F. Scano.
Collection and assembly of data: E. Dirlikov, M. Raviglione.
Dirlikov E, Raviglione M, Scano F. Global Tuberculosis Control: Toward the 2015 Targets and Beyond. Ann Intern Med. 2015;163:52-58. doi: 10.7326/M14-2210
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Published: Ann Intern Med. 2015;163(1):52-58.
Since 1990, progress has been made toward global tuberculosis (TB) control, as measured by targets set for 2015. However, TB remains a major threat to health around the world. In 2013, there were an estimated 11 million prevalent cases, and an estimated 9.0 million incident cases occurred globally. Approximately 1.5 million deaths were caused by TB, including 360 000 among people living with HIV. Substantial challenges threaten future control efforts. These include multidrug-resistant forms and co-infection with HIV, as well as other factors, such as the increased prominence of noncommunicable diseases and adverse socioeconomic conditions. Beyond 2015, TB control must be seen as both a public health imperative unto itself and a vital component of economic development plans. To that end, control strategies should exploit technical and operational innovations to improve TB control and care and should promote universal health coverage and social protection mechanisms to expand access to essential prevention, diagnostics, and treatment services while avoiding catastrophic costs incurred by patients.
Timeline of key events and epidemiologic shifts (left) and the evolving global strategies to control TB (right).
BDQ = bedaquiline; DLM = delamanid; DOTS = directly observed treatment, short-course; EMA = European Medicines Agency; FDA = U.S. Food and Drug Administration; FIND = Foundation for Innovative New Diagnostics; Global Fund = Global Fund to Fight AIDS, Tuberculosis and Malaria; MDG = Millennium Development Goal; MDR = multidrug-resistant; TB = tuberculosis; TB Alliance = Global Alliance for TB Drug Development; UN = United Nations; WHA = World Health Assembly; WHO = World Health Organization.
Global tuberculosis trends in prevalence, incidence, and mortality per 100 000 population, 1990 to 2013.
Shading indicates the lower and upper bounds of the 95% uncertainty interval. Data from reference 1.
* Deaths due to tuberculosis among people living without HIV.
Progress toward global TB targets set for 2015 (left) and other indicators of progress and major challenges (right).
Light green means that the global targets were already met, medium green means that the global targets need acceleration to meet the 2015 deadline, and dark green represents major challenges. Circles with 1990 above them signify indicators compared with the 1990 baseline levels, and circles with 2013 above them show estimates for indicators for 2013, as reported in the WHO Global Tuberculosis Report. Data from reference 1. MDR = multidrug-resistant; TB = tuberculosis.
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