Shifting from tuberculosis control to elimination: Where are we? What are the variables and limitations? Is it achievable?

- The World Health Organization (WHO) End TB Strategy aims to end the global tuberculosis (TB) epidemic.
- The WHO 2016 global TB report estimates that 10.4 million new TB cases, 1.8 million deaths, and 580 000 new multidrug-resistant/rifampicin-resistant TB cases occurred in 2015.
- To reach the End TB Strategy milestones for reductions in cases and deaths, the current annual TB incidence decline rate will need to accelerate from 1.5% to 4-5% per year by 2020.
- Further investment in TB prevention, detection, and treatment are required to achieve TB elimination.

Tuberculosis (TB) is a priority in terms of incidence and mortality, with about 10.4 million new incident cases and 1.8 million deaths in 2015. The End-TB strategy recently launched by the World Health Organization in the context of the post-2015 agenda, aimed to achieve TB elimination, represents an evolution of the previous historical strategies originally aimed to achieve TB control. Globally, the current decline in TB incidence is rather slow at approximately 1,5% per year to reach the TB pre-elimination phase by 2035 (A more aggressive approach based on diagnosis and treatment of latently infected individuals has been proposed in the context of TB elimination to ensure future generations free of TB. We describes 4 scenarios which, combined, describe the TB epidemiology in a given setting: 1) in absence of interventions, 2) with early TB diagnosis and effective treatment, 3) with irregular TB treatment, 4) with TB co-infected by HIV not undergoing anti-retroviral treatment. To achieve TB Elimination, a more concerted action by funders and governments will be required for further investments into TB prevention, detection and treatment.