WHO report 2008
Global tuberculosis control
1.1 Goals, targets and indicators for TB control
Global targets and indicators for TB control have been developed within the framework of the MDGs as well as by the Stop TB Partnership and WHO’s World Health Assembly (Table 1.1).1,2,3 The impact targets are to halt and reverse TB incidence by 2015 and to halve prevalence and death rates by 2015 compared with a baseline of 1990. The incidence target is MDG Target 6.C, while the targets for reducing prevalence and death rates were based on a resolution of the year 2000 meeting of the Group of Eight (G8) industrialized countries, held in Okinawa, Japan. The outcome targets, which are related to DOTS implementation, are to achieve a case detection rate of at least 70% under DOTS and to reach a treatment success rate of at least 85% in DOTS cohorts. These outcome targets were first established by the World Health Assembly in 1991. The ultimate goal of TB elimination by 2050, with the target of less than 1 case per million population, has been set by the Stop TB Partnership.
The Stop TB Strategy, launched by WHO in 2006, sets out the major interventions that should be implemented to achieve the MDG, Stop TB Partnership and World Health Assembly targets. These are divided into six broad components: (i) pursuing high-quality DOTS expansion and enhancement; (ii) addressing TB/HIV, MDR-TB and other challenges; (iii) contributing to health system strengthening; (iv) engaging all care providers; (v) empowering people with TB, and communities; and (vi) enabling and promoting research. The Global Plan to Stop TB, launched by the Stop TB Partnership in 2006, sets out how, and at what scale, the Stop TB Strategy should be implemented over the decade 2006–2015, and the funding requirements. This means that in addition to the targets shown in (Table 1.1), the Global Plan also includes input targets (funding required per year) and output targets (e.g. number of patients with MDR-TB who should be treated each year, number of TB patients to be tested for HIV, number of HIV-positive TB patients who should be enrolled on antiretroviral therapy (ART)).
This chapter focuses on the five principal indicators that are used to measure the outcomes and impact of TB control: case detection and treatment success rates (outcome indicators), and incidence, prevalence and death rates (impact indicators). An analysis of progress against other targets is provided in Chapters 2 and 3.
1 Dye C et al. Targets for global tuberculosis control. International Journal of Tuberculosis and Lung Disease, 2006, 10:460-462.
2 The Global Plan to Stop TB, 2006-2015. Geneva, Stop TB Partnership and World Health Organization, 2006 (WHO/HTM/STB/2006.35).
3 Resolution WHA44.8. Tuberculosis control programme. In: Handbook of resolutions and decisions of the World Health Assembly and teh Executive Board. Volume III, 3rd ed. (1985-1992). Geneva, World Health Organization, 1993 (WHA44/1991/REC/1).