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Should we consider a ‘fourth 90’ for tuberculosis?

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The international community has committed to end the tuberculosis (TB) epidemic by 2030. To facilitate the meeting of the global incidence and mortality indicators set by the World Health Organization's End TB Strategy, the Stop TB Partnership launched the three 90-(90)-90 diagnostic and treatment targets in 2014. In this paper, we argue that a ‘fourth 90’—Ensuring that 90% of all people successfully completing treatment for TB can have a good health-related quality of life'—should be considered. Many individuals who successfully complete anti-TB treatment are burdened with lifelong comorbidities—human immunodeficiency virus (HIV) and diabetes mellitus, obstructive and restrictive lung disease, involving lung destruction, cavitation, fibrosis and bronchiectasis, that either pre-existed or developed as a result of TB (e.g., chronic pulmonary aspergillosis), permanent disabilities such as hearing loss resulting from second-line anti-TB drugs, and mental health disorders. These need to be identified during TB treatment and appropriate care and support provided after anti-TB treatment is successfully completed. A ‘fourth 90’ has also been proposed for the UNAIDS 90-90-90 targets similar in scope to what is being suggested here for TB. Adoption by both HIV and TB control programmes would highlight the current focus on integrated person- and family-centred services.
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Keywords: 90-90-90 TB targets; AIDS 90-90-90 targets; people- and family-centred care; ‘fourth 90’

Document Type: Research Article

Affiliations: 1: International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London 2: International Union Against Tuberculosis and Lung Disease, Paris, France 3: International Union Against Tuberculosis and Lung Disease, Paris, France, Liverpool School of Tropical Medicine, Liverpool, UK 4: International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya

Publication date: December 1, 2019

This article was made available online on November 21, 2019 as a Fast Track article with title: "Should we consider a ‘fourth 90’ for tuberculosis?".

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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