On March 24, 1882, Dr. Robert Koch discovered Mycobacterium tuberculosis, the bacteria that causes tuberculosis (TB). Dr. Koch’s discovery was the most important step taken towards the control and elimination of this deadly disease which was rampant during that era causing both morbidity and mortality. At present, March 24 is declared World TB Day, an occasion to raise public awareness on the global effects of tuberculosis.
The theme of World TB Day 2024 - ‘Yes! We can end TB!’ – conveys a message of hope that getting back-on-track to turn the tide against the TB epidemic is possible through high-level leadership, increased investments, faster uptake of WHO new recommendations, adoption of innovations, accelerated action, and multisectoral collaboration.
According to the Global Tuberculosis Report 2023, it was estimated that globally a total of 10.6 million people fell ill with TB in 2022, equivalent to 133 incident cases per 100 000 population. Most TB cases in 2022 were in the WHO regions of South-East Asia (46%) followed by Africa (23%) and the Western Pacific (18%). Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. Only about 2 in 5 people with drug-resistant TB accessed treatment in 2022.
In 2014 and 2015, all WHO and UN Member States committed to ending the TB epidemic, through their adoption of WHO’s End TB Strategy. In 2018, the UN General Assembly (UNGA) held its first-ever high-level meeting on TB. Commitments to the SDGs and End TB Strategy were reaffirmed and new global targets for mobilization of funding and provision of treatment were agreed upon. A second high-level meeting was held in September 2023, alongside high-level meetings about UHC and pandemic prevention, preparedness and response (PPPR). The political declaration on TB included new commitments and targets for the period 2023–2027.
WHO South-East Asia Region also adopted Gandhinagar Declaration in August 2023 to further enhance efforts to end TB. The Declaration calls for establishing high-level multisectoral commission reporting to the highest political level in each country for synergy of efforts among various stakeholders, and to monitor progress towards ending TB and other priority diseases. In addition, the Declaration calls for ensuring appropriate adoption and use of science and technology for equitable and human rights-based TB services.
When considering the national situation, tuberculosis is the second leading infectious disease in Sri Lanka after dengue. TB continues to be a public health problem in Sri Lanka, with an estimated incidence of 62 per 100 000 population (2022) as per WHO estimates. TB treatment coverage (notified/estimated incidence) for 2022 was 60% meaning that around 40% of TB cases either were not diagnosed or reported.
The National Program for Tuberculosis Control and Chest Diseases (NPTCCD) is the national lead organization for prevention and control of TB in Sri Lanka. The services are provided through a network of 26 District Chest Clinics, 2 sub-chest clinics, 108 branch clinics and 189 microscopic centers. Diagnostic culture facilities are available at National TB Reference Laboratory and Intermediate TB Laboratories at Rathnapura, Kandy, Jaffna and Galle.
WHO continues to support the NPTCCD in its efforts in elimination of TB in Sri Lanka. Sri Lanka has committed itself to achieving the ambitious target of bringing down TB incidence to 13 per 100 000 from 65 per 100 000 (the baseline in 2015) by 2035 as per the End TB Strategy.
In 2023, WHO supported the MoH to conduct the mid-term review of the National TB program. Main recommendations of the review included: 1) Strongly considering the creation of a Task Force on poverty associated diseases including TB; 2) Instituting (through policy, practice review and revision) measures to screen and triage all Outpatient Department (OPD) attendees for TB at all health service delivery points; 3) Developing and implementing a plan with milestones and targets to phase out smear microscopy as a TB diagnostic test and replacing it with a WHO recommended Rapid Diagnostic Tests; 4) Determining which populations will benefit from community level screening and for these populations planning to achieve high coverage (ideally at least 90%) of screening using the most sensitive tool/algorithm; 5) Optimizing the TB Diagnostic Network etc.
In addition, WHO provided technical assistance to the MoH in updating the National Strategic Plan for TB, taking into considerations recommendations of TB mid-term review, and commitments made in the United Nations General Assembly’s second high-level meeting on the fight against tuberculosis (22 September 2023) and Gandhinagar Declaration (17 August 2023).
WHO will continue supporting the NPTCCD thorough providing evidence-based policy options for TB prevention and care, ensuring specialized technical support whenever needed and building sustainable national capacity in TB elimination.