The latest five-year plan against tuberculosis makes addressing inequity surveillance and outcomes a priority.
Australia has a new strategic plan to reduce tuberculosis rates and make health outcomes for people affected by TB more equitable.
The Strategic Plan for Tuberculosis Elimination and Equity in Australia 2026-2030 was developed by the National Tuberculosis Advisory Committee on behalf of the Communicable Disease Network Australia. It builds on the Strategic Plan for Control of TB in Australia 2021-2025, which aimed at reducing the overall incidence of TB in the country.
“During 2021–2025, there has been successful development of a number of key guidelines and policy documents to support optimal and harmonised TB management in Australia. These include TB workforce training, management of [multi-drug-resistant]-TB disease, and infection, and revised national contact tracing standards,” the new strategic plan reads.
“While progress is welcome, there are significant limitations in meeting TB elimination objectives. Most centrally, the 2025 TB incidence thresholds for progress towards elimination are unlikely to be met given current trends. The ongoing control of TB transmission in Australia is a critical priority now and for the future, particularly with continued and increasing migration from high-incidence settings.”
The overall TB incidence rate in Australia for 2024 was 5.9 per 100,000, down from 6.3 per 100,000 in 2020 but still short of the 2030 target rate of 4.8 per 100,000. TB was more prevalent among Australian-born Aboriginal and Torres Strait Islanders (3.8 per 100,000 population) compared to the Australian-born non-Indigenous population (0.7 per 100,000 population).
“The overall emphasis of the last decade for Australia’s TB control has been on incidence reduction towards TB elimination,” the strategic plan reads. “This emphasis has been in line with global priorities, and has led to significant structural and programmatic improvements in Australia.”
“However, a substantial focus on incidence reduction over a sustained period has, by design, concentrated on the groups from which the largest number of cases of TB arise, including settings such as household contacts where the risk of local transmission is the highest.
“While critical to maintain such efforts, exclusive focus on reducing the number of TB cases risks overlooking the smaller number of individuals and communities who are at disproportionate risk of worse outcomes and associated programmatic responses.”
As a result, the new strategic plan features two overarching themes:
- Strengthening existing TB management programs, and
- Building avenues for redressing inequity in TB outcomes
The first theme covers areas such as services responsible for the post-migration diagnosis and management of TB, TB surveillance and reporting, ongoing development of the healthcare workforce, whole genome sequencing and bioinformatic analysis, and improving access to personalised treatment though therapeutics and drug monitoring.
Related
This theme aims to deliver a nationally consistent post-migration TB service (as existing jurisdictional healthcare systems and services vary with respect to structure and reporting), a national model of care for the diagnosis and management of TB that can be implemented in primary care, and a framework for an ongoing national review of TB genomic epidemiology, “including consensus models for responding to apparent inter- and intra-jurisdictional TB transmission on the basis of [whole genome sequencing] analysis.”
The second theme will address the disproportionate TB risk and outcomes experienced by Aboriginal and Torres Strait Islander people and communities.
“For Aboriginal and Torres Strait Islander communities, TB is related to compounding disadvantage, and social services and health system failure, all of which are a consequence of colonisation. Aboriginal and Torres Strait Islander peoples and communities are more likely to be exposed to TB in the context of poor quality housing and poverty, develop active disease, and experience delayed and worse treatment outcomes,” the document reads.
“The overall aim of this focus area is to eliminate local transmission of TB in Aboriginal and Torres Strait Islander communities, and achieve pre-elimination benchmarks in parity with Australian-born non-Indigenous Australians by 2030, as a milestone toward full elimination. Substantial investment in housing and health care access is required to redress this inequity.”
Other focus areas covered by the second theme include quantifying the burden of perinatal TB, quantifying the long-term impact of TB and its treatment in Australia, and quantifying and reducing the financial impact of TB in Australia.
“Post-TB disease (that is, the range of persistent physical impact which may follow microbiological cure) has been relatively neglected within systems established to manage TB as a public health concern. Following microbiological cure, programs have frequently ceased longitudinal follow up, with limited data collection regarding the long-term impact of TB disease. However, while Mycobacterium tuberculosis may have been eliminated, residual impact from tissue damage may persist, with increasing recognition of the long-term impact that previous disease may have,” the report reads.
The NTAC noted that how the strategic plan will be implemented is still to be determined.
“Coordination and oversight of jurisdictional and interjurisdictional approaches to implementing the elements of the strategic plan will occur through NTAC, CDNA, and [the Australian Health Protection Committee], working in partnership with key stakeholders in Aboriginal and Torres Strait Islander health, migration services, primary care and other areas of clinical and public health practice.
“Recognising the breadth of expertise in qualitative and quantitative research across Australia, research activities aligned with and supporting accomplishment of elements of the strategic plan will also be encouraged and incorporated.”
TB is an infection caused by the bacterium Mycobacterium tuberculosis. It typically affects the lungs, but can also affect the brain, bones, and kidneys. People can be infected with M. tuberculosis for months or years before symptoms appear.
Common symptoms of TB disease in the lungs include a persistent cough (lasting two or more weeks), coughing up sputum or blood, fever, night sweats, loss of appetite, unintended weight loss, fatigue, and chest pain.
In Australia, vaccination against TB is recommended for Aboriginal and Torres Strait Islander children aged under five years who live in certain parts of Australia, healthcare workers with an increased chance of exposure, and certain children under the age of five who are (a) travelling overseas to areas where tuberculosis is more common, and/or (b) may be at greater risk of exposure due to a family or household member.
The full strategic plan can be downloaded for free from Communicable Diseases Intelligence.
