From left to right: Jean-Pierre Bosser, Managing Director of the Mérieux Foundation, Alain Mérieux, President of the Mérieux Foundation, Dr Firas Abiad, Lebanese Minister of Public Health, Dr Nadeen Hilal, Senior Advisor for Internal Medicine and Rheumatology at the Lebanese Ministry of Public Health, at the signing of the Memorandum of Understanding to strengthen and coordinate the Lebanese laboratory system in February 2023.
Through a consultative process, the PNLT, the World Health Organization (WHO), the International Organization for Migration (IOM), the Mérieux Foundation, and all the other parties involved in dealing with TB in Lebanon, were consulted in order to develop a Lebanese plan for 2023–2030 in accordance with WHO directives.
With this plan, Lebanon ultimately aims to approach the pre-elimination stage for tuberculosis in the country, with a target of 20 cases per million in 2030 among people born in Lebanon (a 48.1% reduction between 2023 and 2030, or 6.8% per year), and a 50% drop in tuberculosis cases between 2026 and 2030 among people not born in Lebanon.
The national strategy also aims to reduce mortality due to tuberculosis (the case fatality rate) from 8% to 3% between 2023 and 2030.
To achieve this, the plan targets the following four goals:
- Increasing the case detection rate and the coverage of TB treatment from 87% in 2023 to 90% by 2030
- Eliminating tuberculosis in children by reducing the reported incidence of TB in children under the age of 15
- Eliminating multidrug-resistant tuberculosis in Lebanon, with less than one case of multidrug-resistant TB per million inhabitants by 2030
- Achieving, by 2024, a complete description of the TB infection (TBI) cascade in Lebanon, with TB preventive treatment (TPT) for 90% of patients born in Lebanon and refugees by 2030 and 70% of eligible migrants receiving TPT
The plan was published after several months of intensive work coordinated by the PNLT in collaboration with the Mérieux Foundation and all the partners working in the country. The document identifies the strategic interventions and the technical assistance required to achieve the goal and the defined targets. It also defines a number of indicators, including for costs and budgeting. The document lists the planned activities for the operational aspect of the plan, detailing how each three-month period will unfold. The plan involves a number of sub-plans: the basic plan, the budget plan, the monitoring and evaluation plan, the operational plan and the technical support plan.
Context
Tuberculosis (TB) is the second biggest infectious cause of mortality after Covid-19, and the main cause of death among people living with HIV. In 2021, the WHO estimated that there were 10.6 million people with TB worldwide and recorded 1.6 million deaths associated with the disease. Low-income countries account for 98% of TB cases. The Covid-19 pandemic greatly hindered the fight against TB at global level, with a significant drop in case reports and mortality increasing for the first time in a decade.
Lebanon is a country with a relatively low burden of tuberculosis (incidence rate estimated at 10 per 100,000), with a seronegative mortality rate estimated at 1 per 100,000 inhabitants, a tuberculosis case fatality rate (estimated mortality/estimated incidence) of 8% and a high level of successful treatment (generally > 80%).
Since 2018, the Mérieux Foundation has been coordinating its tuberculosis activities with the Lebanese national tuberculosis program (PNLT), including its recent contribution to the drafting of the national strategic plan. Fighting tuberculosis is one of the priority areas of intervention for its work in Lebanon.