Tuberculosis in BRICS: challenges and opportunities for leadership within the post-2015 agenda.

Perspectives Tuberculosis is a disease of poverty that claims the lives of over a million people annually. 1 Globally, tuberculosis is concentrated in low-to middle-income countries. The five countries – Brazil, the Russian Federation, India, China and South Africa – that make up the BRICS group account for 46% of all incident cases of tuberculosis and 40% of all tuberculosis-related mortality. China and India alone account for almost 40% of the estimated global burden of tuberculosis and a similar proportion of all cases notified to the World Health Organization (WHO). South Africa accounts for 30% of the estimated global number of incident cases of tuberculosis–human immunodeficiency virus (HIV) coinfec-tion. In terms of multidrug-resistant tuberculosis (MDR-TB), China, India and the Russian Federation together account for more than half – 56% – of the estimated global burden. Brazil alone accounts for about a third of the western hemisphere's estimated burdens of tuberculosis and MDR-TB. 1 Global efforts to control tuberculosis have had considerable success. These efforts have resulted in substantial progress towards halving tuberculosis prevalence and mortality between 1990 and 2015 (current targets of the Stop TB Partnership) and halting and reversing the incidence of tuberculosis by 2015 (Millennium Development Goal 6c). Despite this progress, about three million people developing tuberculosis are missed by national notification systems each year, only a small fraction of MDR-TB cases are being treated and the poor and vulnerable continue to suffer disproportionally. 1 It is time to look at the enormous challenges that will have to be faced in the post-2015 agenda and the expanded leadership role that BRICS can – and should – play in the fight against tuberculosis. The five BRICS countries were grouped together because they were all fast-growing economies but they also have another similarity: they each harbour more tuberculosis cases than any other country or territory in their respective WHO region. In terms of tuberculosis, each also has different weaknesses and challenges to confront. South Africa has a staggering burden of tuberculosis–HIV coinfection. Brazil and the Russian Federation are trying to eradicate intense foci of tuberculosis among some of their most vulnerable subgroups including homeless people, prisoners, people who use drugs and indigenous populations. China is now faced with the challenge of urgently scaling up access to treatment for MDR-TB. India has more missed cases than any other country and it is difficult to assess the quality of tuberculosis care provided …