Giovanni Battista Migliori

Digital health for the End TB Strategy: developing priority products and making them work

In 2014, the World Health Organization (WHO) developed the End TB Strategy in response to a World Health Assembly Resolution requesting Member States to end the worldwide epidemic of tuberculosis (TB) by 2035. For the strategys objectives to be realised, the next 20u2005years will need novel solutions to address the challenges posed by TB to health professionals, and to affected people and communities. Information and communication technology presents opportunities for innovative approaches to support TB efforts in patient care, surveillance, programme management and electronic learning. The effective application of digital health products at a large scale and their continued development need the engagement of TB patients and their caregivers, innovators, funders, policy-makers, advocacy groups, and affected communities. In April 2015, WHO established its Global Task Force on Digital Health for TB to advocate and support the development of digital health innovations in global efforts to improve TB care and prevention. We outline the groups approach to stewarding this process in alignment with the three pillars of the End TB Strategy. The supplementary material of this article includes target product profiles, as developed by early 2016, defining nine priority digital health concepts and products that are strategically positioned to enhance TB action at the country level. Priority digital health products will be profiled and developed to support the scale-up of WHOs End TB Strategy http://ow.ly/4mRRjR

The role of eHealth and mHealth in tuberculosis and tobacco control: a WHO/ERS consultation

Both tuberculosis (TB) and tobacco consumption are major global public health concerns. About 9 million new cases of TB emerge each year and 1.5 million people die from the disease, despite the fact that TB is eminently curable in the large majority of cases with an affordable course of drugs [1]. Tobacco is the largest preventable cause of death in the world: almost 6 million people die from tobacco use and exposure each year, accounting globally for 6% of all female and 12% of all male deaths [2]. This number is set to increase to 8 million in 2030, or 10% of all deaths projected to occur that year. The burden of tobacco use is greatest in low- and middle-income countries and, unchecked, this trend is likely to increase in coming decades. There is a strong association between smoking and TB [3, 4]. Smoking substantially increases the risk of contracting TB and dying from it. Recent studies of risk factors have attributed more than 20% of global TB incidence to smoking [5]. As a result, smoking cessation is one of the interventions that can prevent TB and, among those who already developed the disease, improve its outcomes [6]. eHealth and mHealth in tuberculosis and tobacco control: WHO/ERS consultation http://ow.ly/Owy38

Cost-effectiveness of treating latent tuberculous infection: a step towards elimination?

WHILE TUBERCULOSIS (TB) control is traditionally based on ensuring rapid detection and the effective cure of infectious TB patients to break the chain of transmission, TB elimination is aimed at reducing the prevalence of latent tuberculous infection (LTBI), based on preventive treatment of latently infected individuals, so that future cases of TB will be prevented.1 In 1990, low TB incidence countries committed to the elimination of TB (i.e., <1 sputum smear-positive case per 1 million population).2 In this issue of the Journal, Shepardson et al. describe the costs and the cost-effectiveness of a new short-course therapy regimen consisting of 12 doses of weekly isoniazid plus rifapentine (3HP) that may have the potential to revolutionise the treatment of LTBI.3 In this important work, they have translated the results of a large, randomised controlled trial conducted from June 2001 to February 20084 into economic terms. In that trial, the 3HP regimen administered as directly observed therapy (DOT) proved at least as effective as or slightly superior to 9 months of daily, selfadministered isoniazid (9H). Looking at a 20-year period, an often used time-frame for economic analyses, the authors show, compared to 9H, 5.2 fewer TB cases and 25 fewer lost quality-adjusted life years (QALYs) gained by 3HP per 100 000 individuals. Given the current price of rifapentine in the United States, it is not surprising that moderate incremental costs will be incurred, with

Tuberculosis, Public Health Aspects

4565 and

Prospective multicentre study on the evaluation of antituberculosis treatment results in Italy: comparison of the culture- versus the smear-based methods

911 more per QALY gained from a health care and societal perspective, respectively. Although these fi gures appear clearly acceptable from a health economic perspective, which generally still considers an upper end of

148 – Antituberculosis Agents

50 000 per QALY gained for the costs of an intervention as cost-effective,5 the outcome of this study is at fi rst glance disappointing. In fact, however, the authors base their subtle analysis on some very cautious assumptions that warrant closer examination. Shepardson et al. start—and rightly so—with the current price of

Iconography : The challenge of the new tuberculosis drugs

12.31 per single 900 mg tablet of rifapentine vs.

Iconography : Breaking the barriers: Migrants and tuberculosis

0.05 per single dose of isoniazid. However, there would likely be a price decrease for rifapentine if blister packs containing the required 12 doses of rifapentine and isoniazid were mass-produced for a growing market of individuals with LTBI. Reducing the cost per 3HP dose to

Thirdly, in our opinion S. Srivastava and colleagues are right to suggest that therapeutic drug monitoring represents the future for improving the quality of second-line anti-TB drugs prescription.

10, i.e., by only about 19%, would already result in cost savings of this regimen from a societal perspective. Because the original results of the trial were based on DOT for the 3HP regimen, the resulting economic consequences are doubled. Not only do the 12 visits by health care workers for the supervised drug intake amount to

Rational use of tuberculosis drugs to prevent the development of drug resistance

188.64, the analysis also takes into account a monetary equivalent of