Abstract
The WHO TB Compendium facilitates the delivery of high-quality care to all persons affected by TB http://ow.ly/VzsM30iO8sO
Tuberculosis (TB) is a global public health priority, with 10.4 million people developing the disease in 2016 (10% among HIV co-infected individuals), 1.67 million deaths and 490 000 multidrug-resistant (MDR) plus an additional 110 000 rifampicin-resistant cases [1].
In 2014, the World Health Organization (WHO) launched the End TB Strategy [1] within the framework of the United Nations Sustainable Development Goals (SDGs). The new strategy was designed to be consistent with the preceding WHO-recommended strategies for TB care and control [2]: the DOTS strategy (launched in 1994, creating the basis for effective TB care and management activities by standardising the requirements to address the epidemic) and the Stop TB Strategy (launched in 2006, aimed at tackling the emerging priorities, such as MDR-TB and TB/HIV co-infection).
In order to end the TB epidemic (which is one of the SDG targets) several interventions need to be implemented. They include the core anti-TB interventions (diagnosis, treatment and prevention), which are described under Pillar I of the Strategy; and several socioeconomic and public health interventions, which are often under the responsibility of ministries other than the ministry of health (e.g. economy, finance, interior or justice) and are presented under Pillar II. Intensified research activities and innovation are covered by Pillar III.
The multidimensional interventions of the End TB Strategy and their potential impact on the TB epidemic are summarised in figure 1, and apply to both high and low TB and HIV burden settings. In countries at low TB incidence (<10 cases per 100 000 population), optimal application of the principles of the strategy should allow approach of the pre-elimination threshold (<10 TB cases per million population) and hopefully also the TB elimination one (<1 TB case per million) by 2035 [4–7].
Projected global trajectory of tuberculosis (TB) incidence rate 2015–2035 required to reach 2035 targets of the End TB Strategy. Reproduced and modified from [3] with permission.
In November 2017, WHO launched a core document: the “Compendium of WHO guidelines and associated standards: ensuring optimum delivery of the cascade of care for patients with tuberculosis”, hereafter referred to as the Compendium. It is structured into WHO-recommended TB standards and consolidates all current WHO TB policy recommendations into a single resource. The document thus provides a framework for reaching the ambitious targets in the End TB Strategy [3].
The aim of this editorial is to introduce this comprehensive resource to a wide audience. The Compendium is relevant for all healthcare providers (clinically oriented as well as public health-oriented readers) in both the private and public sectors.
The document describes the principles on which the End TB Strategy is based (such as ethical considerations, community engagement, public–private mix and engaging all care providers) and provides insight to the formal WHO policy development process. Furthermore, the Compendium covers the activities of Pillar I of the End TB Strategy, focusing on integrated, patient-centred diagnosis, treatment and prevention of TB in adults and children, within close collaboration involving civil society, the social sector, local communities and other stakeholders [3].
The Compendium has been developed as a clear and concise instrument to facilitate the understanding and planning of delivery of high-quality care for everybody affected by TB. It follows the pathway of persons with signs or symptoms of TB in seeking diagnosis, treatment and care, and includes key algorithms and cross-cutting elements that are essential to a patient-centred approach in the cascade of TB care.
Beyond accelerated implementation of existing tools, an effective TB response must embrace innovation through the rapid uptake of new interventions such as rapid diagnostics, new medicines and digital platforms to modernise care provision. Working with communities, civil society and all partners, governments need to assume full responsibility for ensuring person-centred, modern, high-quality TB services and securing comprehensive care along with essential support for each person with TB, which also calls for collaboration within and beyond the health sector. The Compendium is consistent with the principles of International Standards of TB Care [8] and with the European Standards for TB Care [9] in stressing the need to engage all care providers regardless of whether care is sought from public, voluntary, private or corporate care providers.
The Compendium will be updated regularly, including in digital format, to allow incorporation of new evidence emerging from the rapidly evolving TB diagnostic and treatment landscape.
The Compendium includes 33 standards (tables 1 and 2). Table 1 presents the WHO standards for early TB detection, reminding clinicians and other healthcare providers that prompt clinical evaluation for TB is essential (standards 1–4). Standards 5–10 are focused on the importance of quality-assured diagnostic tests for the detection of drug-susceptible and drug-resistant TB. Standards 11 and 18 provide guidance for the diagnosis and treatment of latent TB infection. Standards 12–17 relate to the treatment of both drug-susceptible and drug-resistant TB cases.
Summary of the World Health Organization (WHO) standards for early detection, diagnosis and treatment of tuberculosis (TB) (susceptible and drug-resistant) and latent tuberculosis infection (LTBI)
Summary of the World Health Organization standards for HIV infection and other comorbid conditions, tuberculosis (TB) in children, monitoring and evaluation activities, and supportive approaches to the management of TB patients
Table 2 presents the summary of the WHO standards for TB comorbid conditions (standards 19–22), TB in children (standards 23–26), monitoring and evaluation activities (standard 27), and supportive approaches to the care of TB patients (standards 28–33).
Given that the Compendium represents a consolidated document summarising all current WHO policies and supportive approaches for TB diagnosis treatment and care delivery, it will be useful to inform national TB programmes when drafting local adaptations of WHO specific guidelines. It should also serve as a resource for private sector clinicians to support their care delivery for all patients affected by TB.
Acknowledgements
The contributors to the Compendium are Annabel Baddeley, Annemieke Brands, Monica Dias, Dennis Falzon, Haileyesus Getahun, Christopher Gilpin, Philippe Glaziou, Malgosia Grzemska, Yohhei Hamada, Ernesto Jaramillo, Alexei Korobitsyn, Knut Lönnroth, Fuad Mirzayev, Linh Nguyen, Kefas Samson, Lana Syed, Mario Raviglione, Hazim Timimi, Mukund Uplekar, Wayne van Gemert, Diana Weil, Karin Weyer and Matteo Zignol (all Global Tuberculosis Programme, WHO, Geneva, Switzerland).
Footnotes
Conflict of interest: None declared.
- Received January 16, 2018.
- Accepted March 5, 2018.
- The content of this work is copyright of the authors or their employers. Design and branding are copyright ©ERS 2018.
