What would it take to eliminate tuberculosis in the Eastern Mediterranean Region? (Editorial).

Twenty-five years ago, tuberculosis (TB) was declared a global health emergency by the World Health Organization (WHO). However, TB still remained one of the top 10 causes of death worldwide in 2015. In 2014, the World Health Assembly (WHA) had approved a new global strategy to end TB that builds on successes achieved by the DOTS and the Stop TB Strategy. The End TB Strategy 2016-2035 envisions a world free of TB by pursuing policies that promote prevention and care, and encourage research and innovation, which is in line with the Sustainable Development Goals (SDGs) calling for the TB epidemic to end by 2030. In 2002, the Global Fund to fight AIDS, Tuberculosis and Malaria - a partnership between governments, civil society, private sector and patients - was launched to raise significant funds to support programmes in countries and communities most in need.

Collaboration between tuberculosis control programs and the action plan for tackling antimicrobial resistance: An opportunity in the Eastern Mediterranean Region.

OBJECTIVE/BACKGROUND: Over-the-counter availability of antibiotics together with poor access to diagnostics is recognised to promote antimicrobial resistance (AMR) including generation of drug-resistant tuberculosis (DR-TB). In accordance with the End TB Strategy target of ending TB epidemic by 2030, efforts to control DR-TB are ongoing in Eastern Mediterranean Region (EMR) countries, a number of which have well-established facilities for diagnostics, disease care and prevention as well as surveillance. These could serve as models for AMR control. The United Nation's historic 2016 declaration recognises AMR as a threat to health, food production and development, and emphasises the need for global action. In view of this declaration, establishment of collaboration between the DR-TB and AMR activities would be mutually beneficial and lead to strengthening of both programs. METHODS: Available information on TB control and AMR programs in EMR was reviewed. To assist with policy and planning strategies for promoting collaboration between AMR and TB, control activities were explored. RESULTS: Review of available information suggests gaps in TB care in many countries in EMR, most of which are linked to limited access to resources. At the same time, the fledgling AMR programs have a lot to learn from the experiences, successes and challenges faced by TB control efforts. A logic model is presented to enhance interprogram collaboration. CONCLUSIONS: Given the global commitment and potential availability of resources towards controlling AMR, collaboration between the two programs is discussed towards a more efficient use of resources in the region.

Situational analysis of tuberculosis control programs in the Eastern Mediterranean Region: Gaps and solutions.

OBJECTIVE/BACKGROUND: The objectives of this study were to highlight the key challenges and the strategic directions to scale-up tuberculosis (TB) care in the Eastern Mediterranean Region (EMR); to review TB burden in EMR, and evaluate the progress toward Millennium Development Goals (MDGs) targets by 2015; to identify the main obstacles for optimal TB care toward TB elimination; and to provide strategic directions to address the key challenges. The Eastern Mediterranean Region is composed of 22 countries with 648 million populations. The region has estimated TB incidence of 116 per 100,000. The estimated number of incident TB cases in 2015 was 749000 TB case. METHODS: The paper is based on the Annual World Health Organization Global TB report on implementation of TB control strategy. RESULTS: The EMR is a middle TB- and MDR-TB-burden region with 22 countries. As for MDGs, the region was able to meet the mortality target and revert TB incidence but could not achieve the prevalence target. The main challenges are limited infrastructure, human capacity, funds, use of new diagnostics tools and new medicines, and involvement of all stakeholders and community in TB care and control in addition to complex emergencies. CONCLUSION: The year 2015 marks a transition from the MDGs to the Sustainable Development Goals and from the Stop TB Strategy to the End TB Strategy. The region will move into three main directions: complete pending tasks, mitigate the impact of the complex emergencies on TB control, and move toward TB elimination.

Multidrug-resistant tuberculosis, Somalia, 2010-2011.

In a nationwide survey in 2011, multidrug-resistant tuberculosis (MDR TB) was found in 5.2% and 40.8% of patients with new and previously treated TB, respectively. These levels of drug resistance are among the highest ever documented in Africa and the Middle East. This finding presents a serious challenge for TB control in Somalia.