Stop TB Partnership

Part II - Global & Regional Scenarios for TB Control 2006-2015

Part I of this Global Plan set out the strategic directions to reach the Stop TB Partnership’s global targets for TB control for 2015, which are linked to the MDGs. Part II describes ambitious but realistic scenarios (available by clicking the links in the menu on the left) for the impact and costs of planned activities for the regions with a high burden of TB, while Part III summarizes the specific strategic plans of the seven working groups and the Partnership secretariat for the period 2006 - 2015.

The analytical process that underpins the Global Plan

The Stop TB Partnership has been conscious that the working group plans must be based on sound epidemiological analysis and robust budget justifications in order to provide a powerful argument for resource mobilization. The development of each working group’s strategic plan and of the overall Global Plan has therefore been informed by an analysis of the expected impact, with the accompanying costs, of the planned scale-up of activities oriented towards achieving the targets for 2015. The analysis has required close interaction between representatives of all the Partnership’s working groups, WHO Regional Offices and the team assessing the epidemiological impact and costs of the currently available and new tools.

Scenarios for implementation for 2006 - 2015 have been developed globally and for seven of the eight TB epidemiological regions: Africa, high HIV prevalence, and Africa, low HIV prevalence, which are presented together; American Region (AMR) - Latin American countries (LAC); Eastern European Region (EEUR); Eastern Mediterranean Region (EMR); South-East Asian Region (SEAR); and Western Pacific Region (WPR). The Established Market Economies (EME) and Central Europe are considered together as one epidemiological region in section 9. However, because they have similarly high per capita income rates and low tuberculosis incidence rates, detailed implementation scenarios have not been developed.

In developing the scenarios, assumptions have been made about the pace of scale-up and the coverage of different activities. Estimates have been made of TB case detection and treatment outcomes over the next 10 years, as well of TB prevalence, incidence and death rates in relation to the 2015 targets. The scenarios also include estimated costs of country implementation as well as external technical support.

These regional scenarios are not implementation plans, though the methodology offers an approach that can be applied at country level. The next step will be to develop detailed regional and country implementation plans (integrating DOTS Expansion, DOTS-Plus and TB/HIV actions), based on the respective strategic plans. But the regional scenarios are indicative of what could be achieved, with ambitious but realistic assumptions. They try to predict what could happen if TB control activities go well, while taking into account general barriers that are difficult to overcome during the ten-year time-span of the Global Plan, or that lie outside the domain of TB control, such as severe health systems constraints.

The current epidemiological modelling does not include any assumptions about poverty reduction and its impact on the TB epidemic. If there are considerable socioeconomic improvements as a result of action to achieve other MDG targets, the prospects of reaching the TB control targets earlier - in Africa and Eastern Europe, for example - will be much better. Similarly, if new preventive, diagnostic or treatment tools become available, they could have dramatic effects on the TB epidemic.

The global scenario for meeting the MDG target and the Partnership’s 2015 targets

As described in Part I, under this ambitious but realistic scenario, all regions will see incidence, prevalence and death rate trends go down rapidly over the next 10 years as a result of the various planned TB control activities.

The MDG target to "have halted and begun to reverse the incidence of TB by 2015" will be met in all regions.

In addition, the Partnership’s own challenging 2015 targets - to halve prevalence and death rates from the 1990 baseline - will be met globally, with potentially enormous progress in all regions.

Halving TB prevalence and death rates in individual regions

The scenarios generated in the planning process showed that the Partnership’s targets of halving prevalence and death rates could be achieved by 2015 in most regions where the TB epidemic is concentrated. However, the scenarios showed that these targets would not be achieved by 2015 in Africa and Eastern Europe. The profiles in section 7 include details of the scenario for all TB epidemiological regions, while section 8 considers what further measures would be needed to achieve the targets on time in Africa and Eastern Europe.

Regional Profiles: An Ambitious but Realistic Scenario

Each regional profile is set out in the following format:

  • achievements;
  • challenges;
  • priority activities;
  • expected effects and costs;
  • chart showing planned scale-up of activities;
  • table of milestones related to implementation of DOTS expansion, DOTS-Plus and TB/HIV activities;
  • set of six graphs showing estimated impact and costs of planned activities:
    (i) case detection rate (new sputum smear-positive cases),
    (ii) number of cases treated under DOTS and DOTS-Plus,
    (iii) incidence (all forms of TB),
    (iv) prevalence (all forms of TB),
    (v) mortality (all forms of TB),
    (vi) costs per year of DOTS expansion, DOTS-Plus and TB/HIV activities.

The graphs of expected incidence, prevalence and mortality show three different scenarios:

1) No DOTS. This assumes that the strategy was never introduced in any region, so treatment would continue as it was pre-DOTS, with variable rates of case detection and typically lower rates of cure. This gives a baseline against which to compare acquired and future gains.

2) Sustained DOTS. Case detection and treatment success rates increase until 2005, and then remain steady until 2015.

3) Full implementation of the Global Plan.