The WHO American region (North America, Latin America and the Caribbean) was the first to meet the Millennium Development Goals 2015 target of reducing the mortality and the incidence of tuberculosis (TB) by 50% from 1990 rates. Despite this achievement, the annual rate of decline in the incidence of TB has slowed down in recent years, particularly in Latin America and the Caribbean (LAC), where TB remains a public health problem with a reported incidence of 32.8 cases/100000 inhabitants and an estimated incidence of 40.5 in 2015. These rates exceed the overall average of 27.1/100000 for the region, but remain lower than the world average, estimated at 141.9/100000 inhabitants.1 The proportion of patients presenting combined TB and HIV infection was 11.8%, and 4508 cases of drug resistance (58.6% of the estimated number) were reported. The nature of the TB problem varies widely in this subregion,2 and few countries fulfill the criterion of low incidence (<10 cases/100000 inhabitants). Those which do are Costa Rica, Cuba, Jamaica, Puerto Rico, and some other Caribbean countries and territories.

The World Health Organization recently launched their Global strategy and targets for tuberculosis prevention, care and control after 2015 (End TB Strategy)3 and Toward tuberculosis elimination: An action framework for low-incidence countries,4 but the LAC subregion is finding it a challenge to implement these programs due to the variability of conditions in each country and territory.

The elimination of TB as a public health problem is defined as an annual incidence of less than 1 case per million inhabitants. For operational reasons and to make the best use of resources, measures aimed to eliminating TB should be directed at low-incidence regions instead of being applied indiscriminately in all countries and territories.4 The 2016-2019 Plan of Action for the Prevention and Control of Tuberculosis of the Pan American Health Organization2 is aimed to reduce TB mortality and morbidity but is not focused on the actions for TB elimination in which some low-incidence LAC countries have already begun to address.5–7

Guided by the “Toward tuberculosis elimination: An action framework for low-incidence countries”4 document, the Latin American Thoracic Society (ALAT) with the support of the European Respiratory Society (ERS) developed a “Roadmap for Tuberculosis Elimination in Latin America and the Caribbean”. This program was discussed in the VIII Meeting of Low-Incidence Countries convened by the Pan American Health Organization,7 and forms part of the ALAT/ERS LATSINTB project (Latin America without TB). This editorial summarizes TB elimination action areas; readers are encouraged to consult the full text, available below as supplementary material (doi:10.1016/j.arbres.2017.07.004), for more detailed information. The introduction of locally oriented national and regional strategies, practice guidelines and operation manuals require mechanisms for the implementation, follow-up, monitoring and evaluation of elimination actions.

Countries with a low incidence of TB are characterized by a low rate of transmission among the general population, occasional outbreaks, higher concentrations in vulnerable populations and the elderly, and a significant impact from migrations.4 Actions for the elimination of TB give priority to reaching vulnerable populations, detecting and treating latent TB, implementing migration policies, correcting social determinants, and fostering political commitment to universal access to high-quality services.4,5

Low-incidence countries in LAC are enhancing their strategic plans and activities aimed to elimination. In recent years, several meetings have been held to set objectives and goals5–7 that can be implemented under the 8 priority action areas defined by the Elimination Framework4, the which the “Roadmap for TB Elimination in Latin American and the Caribbean” recommend to adapt for the LAC, as follows:

Although some wide gaps remain, low-incidence countries in LAC have made significant progress in actions aimed to vulnerable populations, screening of active and latent TB, diagnosis and treatment of resistant TB, surveillance and data systems, and monitoring and evaluation programs.5–7 Areas in which less progress has been made, and where urgent action is required, include care of immigrants, investment in research, and increased political commitment to funding.

In the VIII Meeting of Low-Incidence TB Countries in the Americas,7 the main indicators outlined in the Pan American Health Organization Action Plan2 and 2014–2019 Strategic Plan16 were adopted (Table 1). Additional indicators were percentage of compliance with the annual budget for elimination actions and the plan for monitoring and evaluating activities. Milestones, targets and indicators for each of the 8 priority action areas must be adapted to each country and territory.