In the 5 years addressed by the previous Strategic Plan for the Control of TB in Australia, 2011-2015, Australia has made significant achievements towards TB control including: enhancements to off-shore pre-migration screening, which has stabilised onshore TB rates; attaining greater involvement by governmental and non-governmental organisations in TB programs and initiatives; reviewing jurisdictional responsibilities and TB risk groupings; and expanding Australia’s support of regional and global workforce training, and research endeavours. It will be used to make improvements to this website.
Additionally, 8 priority action areas have been adapted from the WHO global TB strategy for low-incidence countries.6 Australia is committed to achieving the targets specified in these documents which aim to further reduce the incidence, mortality and economic hardship associated with TB (Table 1). As outlined throughout this document, the continuation of current strategies, including maintenance of an appropriately experienced TB workforce, albeit essential, are however insufficient for progressing towards TB elimination. In Australia, TB rates declined significantly between 1954 and 1980 and have remained low (Figure 1). Commonwealth and jurisdictional health departments are responsible for the management and surveillance of TB in Australia. Table 2 provides a summary of Australia’s vision and goals towards TB elimination that aim to achieve the WHO adapted global TB elimination strategy targets for low-incidence countries. Rapid TB diagnosis and treatment 7. The rate amongst non-Indigenous Australian born was 0.8 cases per 100,000 population, below that which the WHO defines as a state of pre-elimination (<1 case per 100,000 population) and a benchmark which was first achieved in 2003.18 Whilst the rate in Indigenous Australians (4.8 per 100,000 population) is low by global population standards, it is 6 times that seen in the non-Indigenous Australian born population (Figure 2). However, it is acknowledged that current tools for diagnosis and treatment of TB are inadequate for accomplishing the WHO End TB Strategy targets.47 Therefore, greater support for research is also required to develop new tools such as diagnostics, novel therapies and vaccines. Ensure the treatment review process for drug resistant cases detected pre-migration and the follow up of these cases after migration is effective. Identify mechanisms to streamline the registration of combination formulations of first line drugs in Australia and to enable easier access to new antimicrobial agents for TB treatment. The significant achievements in the last 5 years have been the strengthening of off-shore screening, which has stabilised onshore TB rates, attaining greater involvement by governmental and non-governmental organisations in TB programs and initiatives, the reviewing of jurisdictional responsibilities and TB risk groupings, and expanding Australia’s support of global and regional workforce training, and research endeavours. Assess with migrant communities the cultural and linguistic acceptability of TB care. However, given increasing global MDR-TB and Australia’s migration trends, it is likely that the relative burden of drug-resistant TB will increase in Australia.42 In 2016, the WHO has given conditional endorsement to a shortened (9-12 month) regimen for the treatment of MDR-TB. Although Australia has maintained a low and stable TB incidence rate since 1985, indicating effective TB control, there has been little progress in incidence reduction in recent decades, with the absolute number of cases increasing over this period.2 The key risk factors found in many parts of the world, including poor TB care practices, poverty, political instability and HIV disease are not major contributors to the epidemiology of TB in Australia. Policy recommendation: latent tuberculosis infection screening and treatment in children in immigration detention (2015). In addition, mortality has declined 22% between 2000 and 2015, with TB treatment estimated to have averted 49 million deaths over this period. Continue support to the Government of PNG for health system strengthening to enable better prevention, detection and treatment of TB, especially support of cross border initiatives for TB control in the TSPZ. Determine the material effects of TB on individuals and families, including financial, educational, employment, accommodation and housing impact. Cross border movements between PNG and the Torres Strait by traditional inhabitants, under the provision of the Torres Strait Treaty, unavoidably pose some risk of TB spread, including drug resistant strains, in the Torres Strait Protected Zone.

Eight priority action areas, that align with the WHO’s adaptation of the global TB strategy for low-incidence countries6, have been identified to guide Australia’s approach towards pre-elimination and elimination goals for TB. Effective political engagement is required to increase regional bilateral and multilateral programs for improved TB management. Collaborative research must be part of capacity building efforts to improve TB control in the Asia-Pacific region, including DR-TB, consistent with Objective 5 of the National AMR Strategy: Agree a national research agenda and promote investment in the discovery and development of new products and approaches to prevent, detect and contain antimicrobial resistance.19, Countries in the Asia Pacific region account for 58% of the global TB burden and are a key source of DR-TB.2 Given that local TB epidemiology is heavily dependent on international migration, programs to reduce TB incidence in high burden countries are also likely to lead to additional public health and cost-benefits for Australia.48. As such, this Strategic Plan is directed at all those who must take on the responsibility of improving further TB control in this country. In 2014, the World Health Assembly, which Australia is a Member State, approved with full support the ‘End TB Strategy’4,5. The quality of surveillance should be continuously improved through regular evaluation and systematic strengthening, utilising advances in technology. The long-term vision of the strategy is a world free of TB and the strategy goal is to end the global TB epidemic by 2035, defined as a global incidence of fewer than 100 cases per million population. The scope of services of the reference laboratories covers diagnostic and reference functions including smear microscopy, rapid molecular tests for diagnosis and resistance detection, liquid and solid culture, drug susceptibility testing, molecular typing and genomic sequencing for resistance detection.

For low-incidence countries (defined as <10 cases per 100,000), the WHO has set a target for the pre-elimination of TB (defined as <10 cases per million population) by 2035, and a further target of TB elimination (defined as <1 case per million population) by 2050. Australia continues to use its well validated programmatic approach to TB control. Evaluate current migrant screening programs, including pre and post-migration management and outcomes to identify opportunities for further targeting and strengthening of the programs. Any reduction in political commitment and funding for TB services can result in substantial impact on public health.29 Previously, well-documented community transmission of TB, including increased drug-resistance and greatly increased healthcare costs, has been linked directly with reduction in TB funding and services, such as in the United States.30 Australian jurisdictional TB programs must be supported appropriately into the future to ensure a skilled workforce is available and high quality programmatic and clinical management is available without individual costs to affected people, particularly in light of increased numbers of drug-resistant TB cases in our region and other challenges to effective TB control globally. In addition, Australian non-government organisations, state based institutions, and individuals are involved in a variety of activities supporting global TB efforts. Australia commits and engages to global and regional TB advocacy and control efforts through collaborative involvement in global and regional activities that align with the WHO’s End TB Strategy. The primary determinants of TB rates in Australia are its national migration, education and employment policies, which drive high numbers of migrants that may come from high TB burden countries. Comments will be used to improve web content and will not be responded to. Australia has a requirement for pre-migration screening for active TB but it is not undertaken for all visa applicants, and in some circumstances may not be comprehensive enough. One of the key objectives of the National AMR Strategy, Objective 6, is to strengthen international partnerships and collaborate on global and regional efforts to respond to antimicrobial resistance issues, including issues relating to the prevention and management of DRTB. This Strategic Plan should also be seen as a mechanism to inform our regional neighbours, international health agencies and others of the epidemiology of TB in Australia, the successful achievements to date, the challenges to be met and the strategic direction Australia will take. The burden of TB in Australia will be heavily dependent on future migration trends and policy, being able to control or prevent TB in new arrivals, and being able to rapidly detect TB in migrants as they age.35 International migrants, primarily those from high burden countries, comprise 85-90% of TB cases occurring in Australia.2 Approximately 1,000 migrants living in Australia present annually with active TB predominantly related to an unidentified LTBI acquired outside of Australia. Essential components of a tuberculosis control program within Australia (2014). 2. Review current collection of TB risk factor data, and determine factors which should be added, in order to better characterise risk groups within the population. Implementation of a strategic approach to elimination of TB in Australia is an opportunity to provide global leadership in establishing policies and practices, and to demonstrate that such approaches can be implemented in efficient and effective ways.

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