TB/HIV: a clinical manual - libdoc.who.int - World Health Organization

2. Targets for TB control.3. TB control policy package.4. Key operations for DOTS implemantation.5. Indicators to measure NTP progress in TB control.2.2.1 Goals of TB controlThe goals of TB control are to reduce mortality, morbidity and diseasetransmission (while preventing drug resistance) until TB no longer posesa threat to public health.The aim is also to reduce human suffering andthe social and economic burden on families and communities as aconsequence of TB. In order to achieve this, it is necessary to ensureaccess to diagnosis, treatment and cure for each patient.2.2.2 Targets for TB control (cure and case detection)a) To cure 85% of the sputum smear-positive PTB cases detected.A national TB programme that achieves at least an 85% cure rate inpatients with sputum smear-positive PTB has the following impact on TB:i) TB prevalence,TB mortality and rate of TB transmission decreaserapidly;ii) TB incidence decreases gradually;iii) there is less drug resistance (which makes future treatment of TBeasier and more affordable).Achieving high cure rates is the highest priority.TB programmes withhigh cure rates rapidly reduce disease transmission.They are likely toattract the majority of existing cases in the community.b) To detect 70% of existing cases of sputum smear-positive PTB.It is important to expand case-finding only when the national TBprogramme has achieved a high cure rate.A national TB programme thathas a low cure rate makes the TB problem worse:i) there are more cases of sputum smear-positive PTB treatment failure;ii) transmission of drug resistance increases.A treatable epidemic becomes an untreatable epidemic.An effective NTP has a high cure rate and a low level of drug resistance.Provided that a high cure rate is achieved, increased case detection ofsputum smear-positive PTB cases will decrease TB transmission.42 AN EXPANDED FRAMEWORK FOR EFFECTIVE TB CONTROL