Médecins Sans Frontières (MSF) and the Stop TB Partnership released the 3rd edition of their report ‘Out of Step,’ based on surveys of TB policies and practices in 29 countries. The survey shows that many countries are out of sync with global policies.

The 1^st edition of the report, published in 2014, monitored progress in eight countries; the 2^nd edition, published in 2015, covered 24 countries. The 2017 edition of Out of Step surveyed 29 countries that account for over 80% of the global TB burden, and covers five key areas: diagnostics, models of care, treatment for drug-sensitive (DS) and drug-resistant (DR) TB, drug regulation, and prevention. In each of these areas, the survey bench-marked uptake of global policies at the level of the countries, to produce a 'dashboard' (Figure) of how countries are implementing policies and interventions that are known to work.

Here are some key findings from the report:

Diagnostic gap

• The diagnostic gap is massive: in 2015 more than 4 million people were living with TB that was either undiagnosed, or not notified
• 15 (52%) of the countries surveyed in the report have introduced Xpert MTB/RIF, a WHO-endorsed rapid molecular test, as the initial test for TB; but only 7 of these countries have implemented this policy widely.

Treatment gap

• In certain conditions and for people eligible, MDR-TB treatments can be shortened to 9 months. This shorter MDR regimen is endorsed by WHO, but only 13 countries(45%) in the report recommend these new shorter treatments in their guidelines; none have made them widely available.
• 79% (23) of the countries surveyed in the report have included the newer drug, bedaquiline in their national guidelines, and 62% (18) of countries include delamanid in their guidelines. However, globally only about 5% of people with DR- TB have access to treatment regimens including new life-saving medicines.

Overall, this valuable report is a wake-up call for the global TB community. It underscores the need for governments to increase efforts to combat TB, invest more resources, and work much harder to offer quality care to their patients with TB.

MSF and Stop TB Partnership have launched a campaign called #StepUpforTB (www.stepupfortb.org), to urge governments to bring their TB policies and practices in line with WHO recommendations. Please take a minute to join and support this campaign!