Testing and Treating the Missing Millions with Tuberculosis

In a Guest Editorial on World TB Day, Madhukar Pai and Puneet Dewan identify programmatic and policy changes needed to end TB by 2035.

Funding: The authors received no specific funding for this work. has, for decades, been an important means to monitor treatment adherence and remains trusted and widely used by public health programs, despite an inconclusive evidence base [11]. In the meantime, the number of mobile phone connections is rapidly approaching the number of people in many lower-and middle-income countries, presenting an opportunity to optimize electronic monitoring of medication adherence in programmatic settings. eHealth innovations can have synergistic impact with improved diagnostics and drug regimens by empowering health care workers to recognize and address attrition along the pathway of seeking health care.
In fact, India is currently experimenting with innovative projects in which private doctors use mobile phones to call a contact center to notify TB cases and ensure that their patients receive e-vouchers for free and appropriate drugs [12]. In just the first few months, private providers have enthusiastically responded and initiated treatment for thousands of patients through these initiatives, and call center operators are actively pushing information on care gaps to patients and providers and facilitating treatment adherence monitoring. These innovative approaches are bringing previously unreported, privately-treated TB patients into the light of public health services, where care and adherence can be monitored. These emerging models are expected to reduce costs to patients and improve adherence and outcomes [12].
None of the above strategies can be implemented at scale without adequate funding by donors, the private sector, and, most importantly, governments. In the long run, TB control will bring significant human, economic, and health benefits to any country [13]. While some countries, such as China, have recognized this, increased their investments in TB control, and shown substantial reductions in disease prevalence [14], other countries continue to lag behind. For example, despite announcing an ambitious plan to dramatically intensify TB control by 2020 [15], India has cut back on both health budgets in general and TB spending in particular [16].
Political leaders and policy makers need to understand that TB cannot be eliminated without investing more resources. Here, advocacy is critical.
There are signs that TB's time in the spotlight is arriving. The United Nations Secretary-General recently appointed Eric Goosby of the United States as the new UN Special Envoy on TB, while actress Emma Thompson stepped forward to serve as a TB ambassador in England. In India, TB came out of the shadows recently, when one of India's most celebrated superstars, Amitabh Bachchan, publicly announced that he was a TB survivor and assumed his new role as TB Ambassador for Mumbai Mission for Tuberculosis Control [12]. Recently, one of India's most popular TV shows, "Satyamev Jayate," focused an entire episode on TB, bringing unprecedented attention to the disease [12].
These advocates and champions are bringing much needed public and political attention to a disease that has been neglected for far too long. We hope such advocacy will enable national TB programs to argue for and get the resources they need to modernize TB control and reach the missing millions.

Author Contributions
Wrote the paper: MP PD. Agree with manuscript results and conclusions: MP PD. All authors have read, and agree that they meet, ICMJE criteria for authorship.