TY - JOUR T1 - Towards tuberculosis elimination: an action framework for low-incidence countries JF - European Respiratory Journal JO - Eur Respir J SP - 928 LP - 952 DO - 10.1183/09031936.00214014 VL - 45 IS - 4 AU - Knut Lönnroth AU - Giovanni Battista Migliori AU - Ibrahim Abubakar AU - Lia D'Ambrosio AU - Gerard de Vries AU - Roland Diel AU - Paul Douglas AU - Dennis Falzon AU - Marc-Andre Gaudreau AU - Delia Goletti AU - Edilberto R. González Ochoa AU - Philip LoBue AU - Alberto Matteelli AU - Howard Njoo AU - Ivan Solovic AU - Alistair Story AU - Tamara Tayeb AU - Marieke J. van der Werf AU - Diana Weil AU - Jean-Pierre Zellweger AU - Mohamed Abdel Aziz AU - Mohamed R.M. Al Lawati AU - Stefano Aliberti AU - Wouter Arrazola de Oñate AU - Draurio Barreira AU - Vineet Bhatia AU - Francesco Blasi AU - Amy Bloom AU - Judith Bruchfeld AU - Francesco Castelli AU - Rosella Centis AU - Daniel Chemtob AU - Daniela M. Cirillo AU - Alberto Colorado AU - Andrei Dadu AU - Ulf R. Dahle AU - Laura De Paoli AU - Hannah M. Dias AU - Raquel Duarte AU - Lanfranco Fattorini AU - Mina Gaga AU - Haileyesus Getahun AU - Philippe Glaziou AU - Lasha Goguadze AU - Mirtha del Granado AU - Walter Haas AU - Asko Järvinen AU - Geun-Yong Kwon AU - Davide Mosca AU - Payam Nahid AU - Nobuyuki Nishikiori AU - Isabel Noguer AU - Joan O'Donnell AU - Analita Pace-Asciak AU - Maria G. Pompa AU - Gilda G. Popescu AU - Carlos Robalo Cordeiro AU - Karin Rønning AU - Morten Ruhwald AU - Jean-Paul Sculier AU - Aleksandar Simunović AU - Alison Smith-Palmer AU - Giovanni Sotgiu AU - Giorgia Sulis AU - Carlos A. Torres-Duque AU - Kazunori Umeki AU - Mukund Uplekar AU - Catharina van Weezenbeek AU - Tuula Vasankari AU - Robert J. Vitillo AU - Constantia Voniatis AU - Maryse Wanlin AU - Mario C. Raviglione Y1 - 2015/04/01 UR - http://erj.ersjournals.com/content/45/4/928.abstract N2 - This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards “pre-elimination” (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions.Action framework for countries with low tuberculosis incidence: a coherent approach for eliminating tuberculosis http://ow.ly/H03ZZ ER -