How can we best address the tuberculosis epidemic?

I read with interest the excellent CMAJ commentary by Campbell and colleagues,1 in which the authors highlight the limitations of current tuberculosis (TB) control strategies for immigration screening.

There has been some recent progress. A new short-course regimen for latent TB infection, which requires just three months of once-weekly rifapentine and isoniazid (3HP), has been shown to be as effective, and perhaps safer, than the existing nine-month regimen of daily isoniazid.2 Many of us, if given a choice, would prefer the 3HP regimen of 12 weekly doses compared to 270 daily doses of isoniazid. Unfortunately, although 3HP has been adopted as a treatment option for latent tuberculosis infection in the United States since 2011, access to this regimen is extremely limited in Canada.

As White and Houben3 wrote in a recent editorial, the most direct and equitable way to progress toward elimination of TB in industrialized countries would be to increase funding for TB control in high-burden countries. In 2005, researchers from Montréal, Quebec, showed beautifully that this approach would not only lower rates of TB but, unlike increasing testing and treatment for latent TB infection, would lead to significant cost savings.4 As Canadians, we have long been proud supporters of global TB control efforts and our international partnerships and aid efforts must continue.