Supporting progress towards the post-2015 targets and regional tuberculosis elimination: a statement of intent from the third meeting of the Asian TB Experts Community

The World Health Organization (WHO) is challenging all countries, both highand low-incidence, to dramatically intensify efforts to meet bold new goals of reducing global tuberculosis (TB) deaths by 95% and the incidence by 90% (<10 cases per 100000 population) by 2035 [1]. This radical strategic change came from the recognition that the current strategy of passive case finding and directly observed therapy (DOT) is not sufficiently curbing the incidence of TB. The new strategy calls for a synergy of interventions to enable early case detection, systematic screening and prevention of TB in contacts (adults and children) and high-risk groups, such as people living with HIV or other immune depressing conditions, people with diabetes, patients receiving dialysis, patients preparing for organ or haematological transplantation, patients with silicosis, prisoners, healthcare workers, homeless individuals, illicit drug users and individuals in communal settings. At the end of 2014, the WHO released the first guidelines on the management of latent tuberculosis infection (LTBI). The guidelines provide evidence based guidance on practices for testing, treating and managing LTBI in infected individuals with the highest likelihood of progression to active disease [2]. Although primarily aimed at high-income or upper middle-income countries, with an estimated TB incidence rate of <100 per 100000 population, they represent an unprecedented gear change in the scaling up of TB prevention as a component of TB control programmes [2]. Figure 1 shows a hypothetical approach to prioritisation of high-risk groups.