Stopping tuberculosis in the 21st century: goals and strategies.

The Stop TB Strategy and the Global Plan to Stop TB were launched in 2006 to achieve the tuberculosis (TB)-related Millennium Development Goals and the Stop TB Partnership targets, and to address new challenges such as that of HIV-associated TB and multi-drug-resistant TB. This paper reviews the historical and recent progress in TB control to show what has changed since the introduction of directly observed therapy (DOTS) in the mid-1990s, why we needed the new strategy and what the global agenda is today. Major progress was seen in most countries in the last two decades. Globally, the estimated rates of TB prevalence and mortality are declining, but not quickly enough to reach the 2015 Stop TB Partnership targets of halving TB prevalence and death rates compared with 1990. In 2007, it was estimated that more than one-third of TB patients were not detected or properly treated under proper conditions. Enhancing case detection, while maintaining high treatment success rates, is essential to achieve the 2015 targets. The ultimate goal of TB control is the elimination of the disease as a public health problem. The Stop TB Partnership aims at eliminating TB by 2050 by reaching a global incidence of disease of less than one case per million population. This target will not be achieved unless TB control efforts are further intensified and effective and affordable new technologies to prevent both disease and infection are developed and rapidly introduced in all countries worldwide.