Table 9. Challenges and recommendations for National TB Programmes.

Category	Challenges	Proposed remedies
End TB Milestones/Targets on TB incidence and mortality	Presented globally as percentage reductions compared with 2015	Change percentage reductions into absolute “national” numbers against which to measure progress and present them for all levels of the health system
Optimize prompt and accurate diagnosis of TB	Inefficient use of smear microscopy and Xpert MTB/RIF	Develop algorithms for best use of smear microscopy/Xpert MTB/RIF; monitor numbers being screened, tests done, and results; monitor operational capacity of MTB/RIF instruments; keep abreast of new diagnostic molecular technology
Provide rapid, complete, and effective treatment to all those diagnosed with TB	Poor linkage of diagnosis and treatment; wrong denominator for measuring treatment outcomes; high rates of “not evaluated”	Monitor and improve linkage to care; use diagnosed TB patients as the denominator for treatment outcomes; obtain treatment outcomes for transfer-out patients
Implement and monitor effective infection control practices for MTB	Poor infection control practices and monitoring of TB infection control	Implement and monitor World Health Organization-recommended guidelines; monitor rates of TB in health workers
Diagnose and treat drug-resistant TB	Poor linkage to care; continued use of inefficient CDST systems at national laboratories; long duration of therapy	Monitor and improve linkage to care; prioritize and plan for more efficient use of Xpert MTB/RIF; aim for short 9- to 12-month multidrug-resistant TB treatment; keep abreast of new diagnostic molecular technology
Diagnose and treat HIV infection and diabetes mellitus	HIV and diabetes increase TB mortality; suboptimal uptake of HIV testing, ART, and CPT; limited screening of TB patients for diabetes	Aim for 100% uptake of HIV interventions; scale up screening of TB patients for diabetes and provide optimal diabetes care during anti-TB treatment
ACF and treatment of LTBI	Poor programmatic implementation of ACF and treatment of LTBI	Design and implement strategies with particular focus on people living with HIV and household contacts
Engage with private-for-profit sector	Poor implementation of the PPM strategy	Focus on ways to improve the PPM strategy, especially in Asia
Empower and strengthen central units of TB Programs	Weak central units	More focus on data-driven supportive supervision, operational research, and sustained financing

ACF, active case finding; ART, antiretroviral therapy; CDST, culture and drug susceptibility testing; CPT, cotrimoxazole preventive therapy; LTBI, latent tuberculosis infection; MTB, Mycobacterium tuberculosis; PPM, public-private mix; TB, tuberculosis.