Tuberculosis-a World Health Organization Perspective

Tuberculosis (TB) remains one of the major causes of human suffering and deaths, causing a pandemic of relevant proportions. However, great progress has been made in the fight against TB in the last two decades following the implementation and scale-up of World Health Organization (WHO) public health strategies. The TB elimination goal can be achieved by 2050, but joint efforts from the international community are required (1). However, several challenges must be faced; in particular, the occurrence and spread of multidrug-resistant TB (MDR-TB), TB and human immunodeficiency virus (HIV) coinfection, the old-fashioned diagnostic, therapeutic, and preventive armamentarium, and the increasing prevalence of chronic conditions fueled by socioeconomic determinants could significantly hamper the elimination. A new comprehensive approach to fight TB, the End TB strategy, was introduced by the WHO in 2014. It is the third WHO public health strategy focused on TB, following the DOTS ("directly observed treatment, short course") (2 – 4) in 1993 and the Stop TB strategy in 2006 (5 , 6). The great success of the first two successful WHO strategies was not sufficient to significantly reduce the annual TB incidence rate to achieve TB elimination by 2050 (i.e., incidence rate of less than one TB case per million population) globally. The principles behind the first WHO strategy were oriented to patient care and interruption of Mycobacterium tuberculosis in the community, through early bacteriological case index detection and the cure of contagious pulmonary forms through a standardized therapy. At the beginning of the century, the widespread occurrence of cases involving TB/HIV coinfection and MDR-TB patients required a more tailored and comprehensive public health strategy (the Stop TB strategy) encompassing the DOTS elements and new tactics adapted to the new epidemiological scenario (e.g., universal access to care for all TB patients, engagement between the private and public sectors, and involvement of the civil society and patients' organizations) in TB control efforts.