**Author details**

**12. Conclusion**

226 Tuberculosis - Current Issues in Diagnosis and Management

Founded in 2001, the goal of The Stop TB Partnership for 2015 was to reduce the global burden of TB disease (deaths and prevalence) by 50% relative to 1990 levels. The reality of the global incidence of all forms of TB in 2012 indicates that this timetable is unrealistic. Despite billions of dollars already spent on TB control programs, less than 2% of drug resistant TB cases currently receive appropriate treatment in high burden countries allowing the disease to spread faster than the implementation of adequate management programs. This dramatic

One of the major challenges now is to develop innovative approaches to expand the detection and treatment of drug resistant cases globally. To achieve this goal, substantial funding and development of extensive human resources is needed. Among the response priorities, the following are of paramount importance: 1) developing tools for rapid detection of drug resistance; 2) clinical trials to test simplified, safe and shorter second-line treatment regimens; 3) developing approaches to enhance treatment adherence; 4) clinical trials to test the efficacy of new prophylactic treatment regimens for contacts of patients; and finally 5) developing safe

However, even with increased detection and treatment of drug resistant TB, focusing on the care of TB and neglecting living conditions in low-income countries has little chance of completely reversing the burden of TB. The severity of the TB epidemic in the Western world during the 19th century was largely due to the low living standards prevalent among the poor during the industrial revolution. As living standards improved, TB mortality began to decrease long before any vaccinations or specific therapy was introduced. Reminiscent of the 19th century situation is the persistence of TB in poor and marginalized populations in most modern cities of the world. As the British historian Thomas Mc-Keown said in 1976, "the overall health of the population is less related to medical advances than to standards of living and nutrition" [101]. Thus the control and eventual eradication of the TB epidemic will need support and cooperation from multiple levels within the medical and scientific community, as well as all levels of government worldwide in order to address living standards and develop better drugs

This work was supported by operating grants from the Canadian Institutes of Health Research and BC Lung Association. The author is supported by scholar awards from the Michael Smith Foundation for Health Research, and the TB Vets Charitable Foundation. The author thanks

situation severely attenuates global efforts to control TB.

and more efficient second-line drugs.

and therapeutic tools for the clinic.

Alice Lau and Jeffrey Helm for their editing help.

**Acknowledgements**

#### Zakaria Hmama

Division of Infectious diseases, Department of Medicine, University of British Columbia, BC, Canada
