Globally in 2016, the total number of new cases of tuberculosis (TB) was estimated at 10.42 million, of which over 160 000 are observed in LAC. The number of TB deaths was estimated at 1.45 million, of which more than 15 000 occurred in LAC. Most of these TB cases and deaths occur disproportionately among men, except in the first 15 years of life were the situation is similar to both genders (GBD Tuberculosis Collaborators et al., 2018[19]). Most cases of TB are preventable if diagnosed and the right treatment is provided. TB was declared a global health emergency by WHO in 1993 and the WHO-coordinated Stop TB Partnership set targets of halving TB prevalence and deaths by 2015, compared with a baseline of 1990. The Sustainable Development Goals foresee the end of the epidemic of tuberculosis by 2030.
The highest incidence rate was seen in Haiti, Peru and Bolivia, with 176, 123 and 108 cases per 100 000 population in 2018, respectively (Figure 3.23). Low incidence rates, below 5 cases per 100 000 population, were reported in Barbados, Grenada, Jamaica and Saint Lucia. Saint Kitts and Nevis reported zero new cases in 2018.
The highest mortality rates due to TB (excluding HIV) were found in Guyana and Bolivia with 15 and 11 deaths per 100 000 population in 2018. The lowest mortality rates are observed in Jamaica, Cuba, Costa Rica and Barbados, all below 1 death per 100 000 population (Figure 3.23).
Although the average TB detection rate in the region is generally high (83% of detection of all cases in 2016), there were a large number of undetected cases in Bolivia and Haiti, where detection rates were 62% and 75%, respectively, the only two countries below 80% (Figure 3.24). High-quality TB services have expanded in LAC countries and many cases are treated, reaching excellent treatment success rates in Grenada, Dominica and Barbados. In contrast, treatment success rate is the lowest in Jamaica with 23% followed by Argentina with 54%, well below the LAC33 average of 76%.
In general, the LAC region is rising to the challenges presented by TB, with incidence and mortality declining steadily since 1990, although regional disparities exist. The average reduction of incidence in the LAC region between 2000 and 2018 was 10%. The strongest decline in this period was observed in Honduras, Barbados and Saint Vincent and the Grenadines with more than 60% reduction, while in Grenada incidence increased by 282%, however, the baseline was low at 0.7 cases per 100 000 population (Figure 3.25).
The LAC region still faces important challenges in TB control, including providing services to those in greatest need, especially the poor and vulnerable. The most relevant strategies to develop in LAC countries include the implementation and expansion of early diagnosis with new rapid molecular tests, the epidemiological study of contacts, the use of shortened multi-drug resistance TB treatment regimens, the reduction of funding gaps and the need for greater technical expertise (PAHO, 2018[20]).
