TABLE 5

Adaptation of the principles of the post-2015 global tuberculosis (TB) strategy to low-incidence settings

1) Government stewardship and accountability, with monitoring and evaluation
In low-incidence settings, government must undertake distinct actions in pursuing its stewardship function. These actions are not just those of public health authorities but necessitate clear roles and accountability of multiple authorities, including associated reinforcement and adaptation of monitoring and evaluation approaches, including cross-border collaboration.
2) Strong coalition with civil society organisations and communities
Reaching vulnerable and marginalised populations requires novel approaches to building coalitions with civil society organisations and communities most affected. This coalition approach can both increase expression of the demand for TB prevention and care and ensures engagement in the formulation of plans and intervention strategies, and their evaluation.
3) Protection and promotion of human rights, ethics and equity
Many of the individuals and groups most at risk of TB exposure, infection, disease and poor outcomes face challenges in the protection and promotion of their human rights in general, and in their right to health specifically. A human-rights-based approach to pursuing TB elimination is necessary. This includes addressing issues of nondiscrimination, availability, accessibility, acceptability and quality of interventions, privacy and confidentiality, participation and accountability. There are a range of related ethical issues that arise in the design and implementation of TB prevention and care interventions. Underlying inequities also need to be addressed in the TB response within and beyond the health sector, such as inequity in economic and social circumstances and related social determinants of disease, and in access to healthcare. There is also a need to address concerns that access to formal health services may disclose the irregular status of some immigrants and have legal implications.
4) Adaptation of the strategy and targets at country level, with global collaboration
The development of this framework itself is an expression of the principle of adaptation of global strategy to country and local context. Global collaboration is a fundamental element of the framework, because many of the challenges, including migration, building political commitment to TB elimination and ensuring a robust research portfolio, necessitate global collaboration.