Prsentation PowerPoint

1
The burden of TB in 2006
1.7 million deaths in 2004 98 of these in
developing world
250,000 deaths due to TB/HIV
MDR-TB present in 102 of 109 countries and
settings surveyed in 1994-2002
8.9 million new cases in 2004 80 in 22
high-burden countries
2
Asia has the highest number of cases and TB has
resurged in Europe...
Estimated number of new cases (all forms)
3
Global incidence is rising at 1 due to increases
In Africa and E. Europe


Africa - high HIV
400
300
Africa - low HIV
200
Estimated TB incidence/100K/yr
World
E Europe
100
0
1990
1995
2000
2005
4
WHO European Region
53 countries
18 high priority countries for TB
25 EU countries
5
TB case notification rate in EUR, 1980-04
Annual TB cases per 100,000 pop.
295,240 East EUR (18 countries)
354,954 All EUR (53 countries)
373,497
54,231 European Union (25 countries)
Year
6
TB incidence in EUR
50/100 000 - overall TB incidence in EUR

• 13/100 000 - first fifteen members of the EU
• 27/100 000 - ten new members of the EU
  (enlargement in 2004)
• 53/100 000 - four countries accessing the EU
• 98/100 000 - countries bordering EU

7
Mean annual change in TB notification rates,
2000-2004
change
No data / lt60 cases/yr -11 to -3 -2 to 1 2
to 6 gt6
EuroTB
8
Proportion of TB cases of foreign origin, Europe,
2004
EuroTB
9
Global TB control targets
2015 50 reduction in TB prevalence and deaths
by 2015
2015 Goal 6 Combat HIV/AIDS, malaria and other
diseases Target 8 to have halted by 2015 and
begun to reverse the incidence Indicator 23
prevalence and deaths associated with
TB Indicator 24 proportion of TB cases
detected and cured under DOTS
2005 World Health Assembly - To detect at
least 70 of infectious TB cases - To treat
successfully at least 85 of detected cases
10
DOTS in EUR
1995 - 6 countries 2004 - 43 countries, 47
population
11
Plan to Stop TB in EEUR achievements

• STOP TB strategy
• DOTS
• MDR-TB, TB/HIV, prisons
• Health system
• All providers
• ACSM, people, patients
• Research

Note DOTS achievements in new smear-positive
pulmonary TB cases
12
Proportion of pulmonary cases with positive
sputum smear, East, 1999-2004
including countries where pulmonary
classification was applied for three or more
consecutive years
13
Treatment outcomes, new definite pulmonary
cases, 2003
Culture positive in EU West and Centre smear
positive in Macedonia FYR and East. Countries
with nationwide representative data excluding 4
countries with lt 10 cases (EU West) Mean
percentage (country range in brackets)
EuroTB
14
Outcomes among new, definite pulmonary TB cases,
EU other regions, 2003
Despite low mortality rates, the proportion of TB
patients notified in the EU who die while on
treatment is substantial, even when compared to
other regions in the world. This is one
limitation keeping many EU countries from
achieving the WHO target of 85 success among
previously untreated pulmonary TB cases.
Mean for 19 EU countries (EuroTB) data from
other regions refer to DOTS cohorts (WHO Global
Tuberculosis Control Surveillance, Planning,
Financing. 2006)
15
East West divide
EuroTB
16
Why the new Stop TB Strategy ? Vision, Goals,
Objectives

• Vision A WORLD FREE OF TB
• Goal To dramatically reduce the global burden
  of TB by 2015 in line with the MDGs and the Stop
  TB Partnership targets
• Objectives
• Achieve universal access to high-quality
  diagnosis and patient-centred treatment
• Reduce the human suffering and socio-economic
  burden associated with TB
• Protect poor and vulnerable populations from TB,
  TB/HIV and multidrug-resistant TB
• Support development of new tools and enable their
  timely and effective use

17
Plan to Stop TB in EEUR Planned milestones
18
What are the main challenges ?

• DOTS not yet fully expanded and of high quality
  everywhere
• TB/HIV, especially in Africa, and MDR-TB,
  especially in former USSR and China
• Weak health systems and services impeding proper
  TB control and care
• Not all practitioners engaged
• Communities un-aware and un-involved
• Research not producing yet new tools and outside
  of the interest of TB "controllers"

19
Western and Central Europe

• Today, mainly sexual transmission in Western and
  Central Europe
• Exceptions significant IDU epidemics in ESP,
  POR, ITA, SWI, POL
• 25-65 of all cases are among MSM
• Up to 75 of all heterosexual cases are among
  immigrants from high prevalence countries and
  women are gt50 of all heterosexual cases
• Vulnerable Groups MSM immigrants, specially
  immigrant women

20
Eastern Europe

• Mainly IDU related transmission in Eastern Europe
• 68-85 of all cases are male
• Up to 30 of infected females are IDU and 50 are
  partners of IDU
• 30-50 of all HIV infections are among those
  under 25 years
• Vulnerable Groups IDU, sex workers, prisoners,
  ethnic minorities, migrants

21
IDU as of all HIV/AIDS casesNOTE of AIDS
cases in countries not reporting HIV
Sources EuroHIV national reports
11
0
25.5
19.4
17
14.5
87
16
90
34
81
83
6
71
82
80
24
16
5
71
29
29
82
74
16
20
2
86
7
32
11
64
lt1
15
51
60
68
4
60
14
3
57
8.2
5
16
1.8
16
22
Males as of all HIV/AIDS casesNOTE of AIDS
cases in countries not reporting HIV Sources
EuroHIV national reports
78
62
25.5
75
71
75
75
16
77
68
73
89
78
71
63
79
81
81
80
66
61
80
84
73
85
72
97
80
80
80
63
90
NA
74
77
71
69
80
72
82
78
70
80
83
64
23
Access to HAART, 03/2003
RUS
EST
LAT
LIT
BEL
UKR
KAZ
MOL
ROM
KYZ
UZB
GEO
AZE
BUL
ALB
ARM
TKM
TJK
TUR
BIH, FYM, YUG
no HAART (lt1)
good coverage (gt70) poor access (
1-10) partial coverage (10-70)
24
Access to HAART, 01/2006
RUS
BEL
UKR
KAZ
UZB
AZE
ARM
TKM
TJK
no HAART very poor coverage ( 1-10) in
the process of scaling up ART poor coverage
(10-50) moderate coverage
(50-75) disputed coverage estimates
or insufficient data
available good coverage (over 75)
25
HIV infection among TB cases, 1998-2004
The proportion of TB cases with HIV infection has
increased in Estonia and Latvia, but is still
highest in Portugal and Spain. In other
countries of the Balkans and East providing data,
levels have remained below 1.
Excluding countries with less than 2 datapoints
in the last 3 years or less than 50 TB
notifications annually
26
Reported to WHO (2005) 52,800 TB patients HIV
tested 5,800 tested positive 14 started the ART
27
Estimated HIV prevalence 2005
HIV prevalence estimated in general population
and TB patients (adults)
Source UNAIDS (2004) WHO Global TB Report (2006)
28
European Framework for TB/HIVInterim policy on
collaborative TB/HIV activities

• Establish the mechanism for collaboration
• Set up a coordinating body for TB/HIV
• Conduct surveillance of HIV prevalence among TB
  patients
• Joint TB/HIV planning
• Conduct monitoring and evaluation
• Decrease the burden of TB in people living with
  HIV/AIDS
• Intensified TB case finding
• Introduce INH preventive therapy
• Ensure TB infection control in health care and
  congregate settings
• Decrease the burden of HIV in TB patients
• Provide HIV testing and counselling
• Introduce HIV prevention methods
• Introduce co-trimoxazole preventive therapy
• Ensure HIV/AIDS care and support
• ART

29

• Cat 1 national adult HIV prevalence gt1 or HIV
  prevalence in TB pts gt5 all activities
  recommended in the Interim policy to be
  considered for implementation
• Cat 2 national adult HIV prevalence below 1
  and administrative areas with adult HIV
  prevalence gt1 - combination of Cat 1 and Cat.3
• Cat 3 national adult HIV prevalence below 1 and
  no administrative areas with adult HIV prevalence
  gt1
• Conduct surveillance of HIV prevalence among TB
  patients
• Decrease the burden of TB in people living with
  HIV/AIDS with focus on groups at high risk for TB
  and HIV IDUs, MSM, sex workers, those living in
  congregate settings)