Accelerating advocacy on TB/HIVVienna, 15 July 2010

TB/HIV in the WHO European Region

Smiljka de LussignyAndrei Dadu, Martin Donoghoe & Richard Zaleskis

Communicable Diseases UnitWHO Regional Office for Europe

Presentation outline

Epidemiology in WHO European Region – TB, HIV & HIV/TB

Regional specificities

Surveillance: most important impact TB indicators

25 - 26 May 2009 3

Indicator What to measure How to measure

Incidence rate(/100,000)

New TB cases estimated in one year-------------------------------------------------- x 100,000Total midyear population

x determinants coefficient

Notification rate(/100,000)

New TB cases notified in one year-------------------------------------------------- x 100,000Total midyear population

Notifications of TB

Case detection rate (%)

New TB cases notified in one year-------------------------------------------------- x 100New TB cases estimated in one year

Reports TB case finding

Prevalence rate(/100,000)

New and old TB cases estimated in one year----------------------------------------------------------- x 100,000Total midyear population

TB prevalence survey

Mortality rate(/100,000)

TB deaths in one year-------------------------------------------------- x 100,000Total midyear population

Vital registration

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Source: Global tuberculosis control: a short update to the 2009 report. WHO/HTM/TB/2009.426

Global & European Region TB burden (2008)

TB case notified in 2008 in the WHO European Regions

EMR7%

AFR23%

AMR4%

EUR6%

SEAR36%

WPR24%

9.4 mln new TB cases estimated globally in 2008 (139 per 100 000 population)

6% contribution of European Region to the Global burden

In 2008, 50 (of 54) countries from the Region reported a total of 461,645 TB cases

The overall TB notification rate was 52.2 per 100,000 population

46% notified cases from Russia

87.6% contribution of 18 HPC to the Regional TB burden

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TB burden WHO European Region (2008)

6

TB notification* rate and estimated incidence WHO European Region (1980-2008)

* Newly notified episodes (TB cases) = new cases + relapses*** excluding Bulgaria and Romania that become EU in 2007

ArmeniaAzerbaijanBelarusBulgariaEstoniaGeorgiaKazakhstanKyrgyzstanLatvia LithuaniaMoldovaRomaniaRussian Fed.TajikistanTurkeyTurkmenistanUkraineUzbekistan

** 18 High Priority Countries

Case Detection Rates WHO Regions (2008)

Overall, about 61% (5.5 million) of the estimated number of incident cases detected Case-detection has been stagnating globally since 2006.

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Notified and estimated TB mortality rates WHO European Region (2003-2007)

9

CDR and TSR of new SS‘+’ TB,18 HPC, 2008

ARM

AZE

BLR

BUL

EST

GEOKAZ

KGZ

LVA

LTU

MLD

ROM

RUS

TJK

TURTKM

UKR

UZB

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80 90 100 110 120

TSR (average in EUR) in 2005: 52/71TSR (average in EUR) in 2006: 55/70

Estimated number ofMDR-TB cases (2009)

10

0-<4,000

4,000-<10,000

10,000-<40,000

approximately 100,000

Among all incident TB cases globally an estimated 3.6% are MDR-TB

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MDR-TB prevalence WHO European Region (2008)

* M/XDR-TB: 2010 global report on surveillance and response (WHO/HTM/TB/2010.3)** TB surveillance in Europe 2008: report (ISBN 978-92-9193-207-8; ECDC, 2010)*** Data considered reliable if 50% of all cases were culture-positive, and 80% of them had reported DST results.

Estimated MDR prevalence, among all TB cases

19.1%

(81,000 cases)*

Notified MDR prevalence, among all TB cases

18.1 %

(18,365 cases)**

Detection Rate of all MDR‐TB cases

22.7 %

Out of 27 countries that account for 85% of all MDR-TB cases, 15 are in the European Region

Cumulative number of reported HIV/AIDS casesin WHO European Region 1985-2008

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

1,100,000

1,200,000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

HIVAIDSAIDS deathspeople on HAART

2%

<20%

20-40%

40-60%

60-80%

6%

5%

11%

9%

>80%

75%

25.5%

9%

5%

88%

57%

80%

28%

65%

57%

59%

16%

13%

17%

4%

15%

16%

<1%

23%

82%

50%61%

14%

71%

11%

5%

IDU as % of all HIV/AIDS cases with known transmission route

NOTE: % of AIDS cases in countries not reporting HIV: France, Italy, Spain Sources: WHO/ECDC, national reports.

11%

15%

26%

5%

77%

2%

17%

0%9%

1%

16%

24%

25%

16%

29%

76%

73%

73%

66%

78%

42%

4%

3%

Scaling up treatment in Europe

16,000

18,00021,000

396,000380,000

350,000335,000

320,000305,000

290,000266,000

35,000

87,000

55,000

27,00023,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

Feb-03

Apr-03

Jun-0

3Aug

-03Oct-

03Dec

-03Feb

-04Apr

-04Ju

n-04

Aug-04

Oct-04

Dec-04

Feb-05

Apr-05

Jun-0

5Aug

-05Oct-

05Dec

-05Feb

-06Apr

-06Ju

n-06

Aug-06

Oct-06

Dec-06

Feb-07

Apr-07

Jun-0

7Aug

-07Oct-

07Dec

-07Feb

-08Apr

-08Ju

n-08

Aug-08

Oct-08

Dec-08

Central and Eastern EuropeWestern Europe

TB/HIV co-infectionWHO European Region (2008)

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• Оценочнаяраспространённость ВИЧ-инфекции среди случаев ТБ = 5.6% ( 23.800 people)• HIV testing coverage = 79% ( 357.000 patients)• HIV prevalence among tested TB = 3.0% ( 11.500 patients)• 48% of TB/HIV patients are detected• 28% of TB/HIV patients are covered by ARV treatment

HIV testing and treatment in TB patients, by WHO Regions (2008)

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HIV case finding among TB patients TB case finding among PLHIVNumber of

TB patients with known HIV status (thousands)

% of notified TB patients tested for

HIV

% of tested TB patients

HIV-positive

% of estimated

HIV-positive TB

casesidentified by testing

% of identified

HIV-positive TB patients started on

CPT

% of identified

HIV-positive TB patients started on

ART

Regional distribution

of estimated TB among HIV-positive

(%)

Number of HIV-positive screened

for TB (thousands)

Number of HIV-positive

people provided

IPT (thousands)

AFR 636 45 46 27 73 30 78 729 26AMR 113 49 15 45 36 67 2.7 48 12EMR 22 5.4 4.1 5.8 39 55 1.1 12 0.7EUR 357 79 3.3 48 61 28 1.7 205 9.2SEA 94 4.1 18 9.3 54 35 13 300 0.2WPR 152 11 7.0 24 55 28 3.1 90 0.7Global 1374 22 26 25 71 32 100 1384 48

Regional challenges

Both epidemics spread within vulnerable “most at risk populations” i.e. drug users, prisoners and migrants

Out of the system, poor access to services, marginalized and stigmatized

Low uptake of HIV testing, limited access to ART

Limited collaboration between the vertical HIV and TB programmes (drug dependence, STIs, viral hepatitis)

Lack of integration between HIV and TB services

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