Alternativas de procesos para la búsqueda de casos de tuberculosis bajo condiciones económicas limitadas. Cuba 2022-2025 / Process Alternatives for the Tuberculosis Case Finding under Limited Economic Conditions. Cuba 2022-2025

Ejecutar procesos efectivos de búsqueda de casos de tuberculosis es crucial para acele-rar el paso hacia su eliminación. El empeoramiento de las condiciones económicas mun-diales y nacionales no nos permite aplicar extensivamente las tecnologías rápidas mo-leculares idóneas de diagnóstico. Consideramos sensato entonces aplicar algoritmos alternativos que satisfagan las necesidades nacionales presentes hasta que las condi-ciones permitan la cobertura completa de las tecnologías moleculares recomendadas. Sugerimos introducir la radiografía digital para todos los algoritmos, utilizar mejor la microscopía de fluorescencia LED y la óptica convencional ya probadas. En conclusión, es preciso que este enfoque de trabajo, que procura optimizar la efectividad y eficiencia del programa, se introduzca en la práctica cotidiana hasta que lo idóneo sea permisible

Executing effective tuberculosis case-finding processes is crucial to accelerate the path towards elimination of the disease. The worsening of global and national economic conditions do not allow us to extensively apply rapid molecular diagnostic technolo-gies. We consider it sensible and necessary to apply alternative algorithms that meet the current national needs, until conditions allow full coverage of the recommended molecular technologies. We suggest introducing digital X-rays for all algorithms, bet-ter use of LED fluorescence microscopy and conventional optics already appropriate-ly tested. In conclusion, it is necessary that this approach that seeks to optimize the effectiveness and efficiency of the Cuban program be introduced into daily practice until the ideal is permissible

Moving Closer to Tuberculosis Elimination through Institutional Scientific Collaboration: Opportunities for Cuba and the USA.

Global efforts to eliminate tuberculosis by 2050 continue to challenge health systems. In countries with low reported tuberculosis incidence, such as the USA (3.1/100,000 population) and Cuba (6.9/100,000), differences in classification by income level and health systems' overall organizational structure are evident. However, the two countries' low tuberculosis incidence, geographic proximity, robust research capacity and shared health priority for tuberculosis elimination provide fertile territory to strengthen collaboration for tuberculosis control in clinical, laboratory and community settings. Two tuberculosis symposia in Cuba-one at the Cuba Salud Convention in 2015 and the other at the International Forum on Hygiene and Epidemiology in 2016-were instrumental in stimulating dialogue on continued efforts towards eliminating tuberculosis by 2050. In this article, we describe tuberculosis burden in the USA and Cuba, critically analyze strengths and challenges experienced in areas of low tuberculosis incidence and provide recommendations for future institutional collaboration to support tuberculosis elimination and improved population health. KEYWORDS Tuberculosis/epidemiology, Mycobacterium tuberculosis, prevention, communicable disease control, disease eradication, disease elimination, international cooperation, Cuba, USA.

Towards tuberculosis elimination: an action framework for low-incidence countries.

This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions.

Tuberculosis pulmonar con baciloscopia negativa, peculiaridades de su frecuencia en Cuba 1992-2002 / Smear-negative pulmonary tuberculosis, peculiarities of its frequency in Cuba 1992-2002

Se estimó el aumento o la disminución porcentual del número de casos de tuberculosis y las tasas de incidencia en los períodos 1992-1994 y 1994-2002. Del total de 11 216 casos, 9 737 (86,8 por ciento) fueron de tuberculosis pulmonar, entre ellos 30,5 por ciento con baciloscopia negativa. Solo se registraron 1 279 casos (13,1 por ciento) de tuberculosis pulmonar BAAR(-) cultivo (+). Hubo 13,2 por ciento de tuberculosis extrapulmonar. Se produjo un incremento desde 7,2 a 14,7 por 105 habitantes, 24,1 por ciento en la tasa global de incidencia de tuberculosis de 1994 con respecto a 1993 y de 53 por ciento respecto a 1992 (5,8 a 14,7 por 105 habitantes). Desde 1994 hasta 2002 se observó una reducción sostenida de 48,3 por ciento (6 por ciento por año), pero las proporciones de las categorías de casos permanecieron estables relativamente. Se observó un incremento importante del número y la tasa de casos de tuberculosis pulmonar BAAR(-) notificados en el período 1992-1994 y una disminución sostenida desde 1995 hasta 2002, muy posiblemente asociada al fortalecimiento de las medidas de control.

The percentage increase or reduction of the number of cases of tuberculosis and the incidence rates in the periods 1992-1994 and 1994-2002 were estimated. Of the total of 11 216 cases, 9 737 (86.8 %) were pulmonary tuberculosis, among them 30.5 % with negative smear. Only 1 279 cases (13.1 %) of smear-negative culture-positive pulmonary tuberculosis were registered. 13.2 % cases had extra pulmonary tuberculosis. There was an increase from 7.2 to 14.7 per 105 inhabitants that accounted for 24.1 % in the global rate of tuberculosis incidence of 1994 compared with 1993, and of 53 % in comparison with 1992 (5.8 to 14.7 per 105 inhabitants). A sustained reduction of 48.3 % (6 % per year) was observed from 1994 to 2002, but the proportions of the case categories were relatively stable. An important growth of the number and the rate of cases with smear-negative pulmonary tuberculosis reported in the period 1992-1994 and a sustained decrease between 1995 and 2002 very possibly associated with the strengthening of the control measures were noticed.

Tuberculosis pulmonar con baciloscopia negativa, peculiaridades de su frecuencia en Cuba 1992-2002 / Smear-negative pulmonary tuberculosis, peculiarities of its frequency in Cuba 1992-2002

Se estimó el aumento o la disminución porcentual del número de casos de tuberculosis y las tasas de incidencia en los períodos 1992-1994 y 1994-2002. Del total de 11 216 casos, 9 737 (86,8 por ciento) fueron de tuberculosis pulmonar, entre ellos 30,5 por ciento con baciloscopia negativa. Solo se registraron 1 279 casos (13,1 por ciento) de tuberculosis pulmonar BAAR(-) cultivo (+). Hubo 13,2 por ciento de tuberculosis extrapulmonar. Se produjo un incremento desde 7,2 a 14,7 por 105 habitantes, 24,1 por ciento en la tasa global de incidencia de tuberculosis de 1994 con respecto a 1993 y de 53 por ciento respecto a 1992 (5,8 a 14,7 por 105 habitantes). Desde 1994 hasta 2002 se observó una reducción sostenida de 48,3 por ciento (6 por ciento por año), pero las proporciones de las categorías de casos permanecieron estables relativamente. Se observó un incremento importante del número y la tasa de casos de tuberculosis pulmonar BAAR(-) notificados en el período 1992-1994 y una disminución sostenida desde 1995 hasta 2002, muy posiblemente asociada al fortalecimiento de las medidas de control(AU)

[Smear-negative pulmonary tuberculosis, peculiarities of its frequency in Cuba 1992-2002]. / Tuberculosis pulmonar con baciloscopia negativa, peculiaridades de su frecuencia en Cuba 1992-2002.

The percentage increase or reduction of the number of cases of tuberculosis and the incidence rates in the periods 1992-1994 and 1994-2002 were estimated. Of the total of 11,216 cases, 9737 (86.8%) were pulmonary tuberculosis, among them 30.5% with negative smear. Only 1 279 cases (13.1%) of smear-negative culture-positive pulmonary tuberculosis were registered. 13.2% cases had extra pulmonary tuberculosis. There was an increase from 7.2 to 14.7 per 10(5) inhabitants that accounted for 24.1% in the global rate of tuberculosis incidence of 1994 compared with 1993, and of 53% in comparison with 1992 (5.8 to 14.7 per 10(5) inhabitants). A sustained reduction of 48.3% (6% per year) was observed from 1994 to 2002, but the proportions of the case categories were relatively stable. An important growth of the number and the rate of cases with smear-negative pulmonary tuberculosis reported in the period 1992-1994 and a sustained decrease between 1995 and 2002 very possibly associated with the strengthening of the control measures were noticed.