After many years of increasing numbers of people being notified to national TB control programs, TB notifications have remained stagnant since 2007 (with a slight increase in recent years due to improved case reporting in India). While other major global TB indicators like treatment success have improved and mortality rates have fallen, there is a persistent gap in the number of people who fail to receive adequate TB care each year. Although an entirely preventable and curable disease, 10.4 million people developed TB in 2016. Only 6.3 million were detected and officially notified, leaving a gap of 4.1 million people who were “missed” by health systems after failing to be diagnosed, treated or reported.
People with TB are currently being missed due to three bottlenecks:
Access to Care: Too many people still have limited access to care. Working with and in communities and private health care providers is essential to improve and expand access.
Screening, Diagnostic and Treatment Services: In many settings, people who are sick with TB have access to health services, yet they are not identified as needed to be tested or are tested but not diagnosed with TB or diagnosed and not treated.
Linkages to Care: Many people are receiving care for TB (often substandard), but are not notified to National TB Programs (NTP).
NTPs and their partners are increasingly focused on trying to close this gap and the new Stop TB Global Plan and End TB Strategy both seek to ensure that all people who are sick are identified and can receive adequate treatment. Global momentum for improving TB case detection and notification further gained track when the Global Fund (GF) established in Catalytic Investments Framework, which comprised Matching Funds to incentivize the programming of country allocations. For the priority area TB, the Matching Funding focus is on finding the missing people with TB. Twelve countries* that together account for 75% of all people with DS-TB and 55% of all people with DR-TB currently missed globally have received this additional investment (total value: USD 115 million) to improve case detection and treatment through innovative and comprehensive case finding approaches during new GF Funding Cycle 2018-2020.
To further support accelerated, innovative case finding in these countries, the Global Fund has made available an additional USD 10 million through the Strategic Initiative to Find the Missing People with TB and commissioned Stop TB Partnership and the World Health Organization (WHO) to provide comprehensive and targeted technical country support for the period 2017/18-2020. The ambitious goal of the Strategic Initiative (SI) is to find 1.5 million people with DS-TB and DR-TB by the end of 2019 (baseline: end of 2015), marking an unprecedented ambition level for the TB community.
The Global Fund, Stop TB Partnership, WHO, countries and partners are all sharing this ambitious target and will be jointly held accountable in their action. Under the Strategic Initiative, Stop TB Partnership and WHO follow a joint work plan to cover different areas of supporting countries in their planning, implementation and monitoring of enhanced case detection interventions, as stipulated in their Global Fund approved Funding Requests/Matching Funding plans.
*The 12 countries are: Bangladesh, Democratic Republic of Congo, Indonesia, Kenya, Mozambique, Myanmar, Nigeria, Pakistan, Philippines, South Africa, Tanzania, and Ukraine.