Healthy Israel 2020: Objectives, targets, and evidence-based strategies to prevent tuberculosis and HIV infection in Israel

Healthy Israel 2020 is Israel's long range health targeting initiative. The TB, HIV, and STI prevention subcommittee was charged with describing the local burden of disease, developing objectives and measurable targets for 2020 and proposing science-based interventions. This chapter focus on TB and HIV prevention. Methods: Morbidity data were derived from two national registries, epidemiological and behavioral surveys. A 5-year TB incidence rate, calculated for each annual cohort of immigration, was adopted for Israeli immigrants. Five year (2015) targets were generated when existing trends could not reliably project 2020 rates. Expert opinion and international experience directed target setting. Interventions were modeled after international best practice and adapted to local conditions. Results: Overall TB incidence decreased from 10.8/100,000 (1998) to 5.5/100,000 (2007). In 2020 TB incidence rate is expected to be reduced among the veteran Israeli population by 50% (to ~1/100,000). Overall HIV incidence is among the lowest in Western European countries (49.6 per million inhabitants, end 2007), but subpopulation groups show wide variability. Conclusions: TB control is currently at an advanced level as compared with many European countries. However, in an era of emerging resistance to TB treatment worldwide, major challenges exist for an immigrant-absorbing country such as Israel. A very specific mix of HIV epidemics exists due to the health history and current behaviors of its varied immigrant groups. To effectively control this complex situation, a multifaceted approach has been developed. However, to meet the ambitious targets set for both TB and HIV control, additional resources are vital.