What's New in WHO Policy Guidance

8/10/2019 What's New in WHO Policy Guidance

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The global burden of tuberculosisProgress, challenges, strategyand opportunities beyond 2015

Barcelona

27 October 2014

Dr Mario RAVIGLIONEDirector


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TB Basics

Burden, Progress, Challenges

Way Forward

This talk will deal with


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Tuberculosis (TB) is one of

the oldest diseases of

humans

Second greatest infectious

killer after HIV/AIDS

TB is also one of the top

killers of women worldwide

TB is curable, if properly

treated

If untreated, TB may befatal

One third of world has

latent TB infection

Tuberculosis: basics


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TextTB is airborne

BacteriumMycobacterium

TB usually affects the lungs, although other

organs are involved in 15-30% of cases


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TB linked to HIV infection, malnutrition,alcohol, drug and tobacco use, diabetes

Migrants, prisoners, minorities,

refugees face risks, discrimination

& barriers to care

510,000 women and 80,000children die of TB each

year; 10 million TB

orphans

TB spreads in poor, crowded & poorly

ventilated settings

Who carries the burden of tuberculosis?

mostly, the most vulnerable


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Estimated numberof cases

Estimated numberof deaths

1.5 million*

80.000 in children 510.000 in women

9million126 per 100,000

550,000 in children 3.3 m in women

480,000

All forms of TB

Multidrug-resistant TB

HIV-associated TB 1.1 million (13%) 360,000

Source: WHO Global TB Report 2014 * Including deaths attributed to HIV/TB

The Global Burden of TB - 2013

210,000


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South-East Asia

37%

Western Pacific18%

Africa29%

E. Mediterranean8%

Europe4%

Americas

3%

35% in India + China

24% in India

Ref:GlobalTBControlReport2014

Estimated TB incidence rate, 2013


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TB cases and deaths in slow decline, 1990-2013

Total mortality peaked in 2002 at 1.7 million

1.5 million in 2013

Incidence peaked at 9.5 million in 2004

9 million in 2013


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Incidence falling

slowly (1.5%/yr):2015 MDG on track

Reductionin TB mortality rate

45% since 1990

37 million lives saved since 2000

4.8 million lives savedsince 2005 through

TB/HIV collaborative

activities

86% cure rate

61 million patients cured,

1995-2013

Global progress on impact - 2013


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Challenges: Priorities for action 2014

5 PRIORITIES FOR ACTION

Reaching the missed cases

(3 million not in the system)

Address MDR-TB as crisis

Accelerate response to TB/HIV

Increase financing to close

resource gaps

Intensify research and ensure

rapid uptake of innovations


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Reaching the "missed" cases(nearly 3 million not diagnosed or reported)

Ref: Global TB Control Report 2013

Share of total missed cases

10 countries account for 74% (2.4 million) of theestimated missed cases globally

9 million estimated

6 million notified

Estimated incidence

Global notifications


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Accelerate response to TB/HIV

Estimated HIV prevalence in new TB cases, 2013


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Address MDR-TB as a crisis:Percentage of new TB cases with MDR-TB


India, China, Russia, Pakistan and Ukraine

have 60% of all MDR-TB cases


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GLOBAL TB

PROGRAMME

The status of the MDR-TB response

THERE IS SIGNIFICANT PROGRESS IN MDR-TB DETECTION BUT

TREATMENT CHALLENGES COMPROMISE GAINS


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GLOBAL TB

PROGRAMME

Five priority actions to address the global MDR-TB crisis

ACTIONS NEEDED ON ALL FRONTS FROM PREVENTION TO CURE


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GLOBAL TB

PROGRAMME

67thWorld Health Assembly, Geneva, May 2014

based on a call from member states in 2012


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GLOBAL TB

PROGRAMME

Target 1

95% reduction in

deaths due to TB

(compared with

2015)

Target 2

90% reduction in TB

incidence rate

(compared with

2015)

Target 3

No affected

families face

catastrophic

costs due to TB

Vision: A world free of TB

Zero TB deaths, Zero TB disease, and Zero TB suffering

Goal: End the Global TB epidemic (


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GLOBAL TB

PROGRAMME

Integrated,

patient-

centered

TB care

and

prevention

Bold

policies and

supportive

systems

Intensified

research

and

innovation

The End TB Strategy: 3 pillars and 4 Principles


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GLOBAL TB

PROGRAMME

Adapting the End-TB Strategy for

low TB incidence countries

Countries with < 10/100,000 TB cases/year, notified all forms cases & > 300k population

Other countries progressing rapidly or with potential to consider elimination in the future


Estimated incidence, new TB cases/year: 155,000

Notified cases/year: 131,000(among women: 50,000; among children: 5,000)

TB deaths/year: 10,000 (30 deaths a day)

Estimated new TB/HIV cases/year: 4,000

Notified MDR-TB cases/year: 567


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GLOBAL TB

PROGRAMME

Targets


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GLOBAL TB

PROGRAMME

Challenges for TB elimination

in low-incidence countries

TB concentrated in vulnerable and high-risk groups

Recent transmission vs. reactivation

Cross-border migration

Dwindling political commitment and visibility


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GLOBAL TB

PROGRAMME

ACTION FRAMEWORK8 priorities for elimination in low-incidence countries

Invest in

research

and new tools

Optimize the

prevention and care

of drug-resistant TB

Address specialneeds of migrantsand cross-border

issues

Address the mostvulnerable and hard-

to-reach groups

Support global

TB prevention, care

and control

Ensure continued

surveillance,programme

monitoring &evaluation, and case-

based datamanagement

Undertake

screening for active

TB and latent TB infection

in TB contacts and

selected high-risk groups,

and provide appropriate

treatment

Ensure political

commitment, funding

and stewardship for

planning and

essential services

of high quality


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GLOBAL TB

PROGRAMME

Reaching the targets:Research and development crucial

Optimize current tools,pursue universal health

coverage and social

protection

Introduce new tools: a vaccine,

a new prophylaxis & treatment

regimen, a PoC test

Average

-10%/year

by 2025

-5%/year

Current global trend: -2%/year

Average

-17%/year


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GLOBAL TB

PROGRAMME

Political commitment needs to bebacked by financing to end the TB epidemic

$2 billion

Funding gap

$8 billion funding required for TB prevention,

diagnosis and treatment

$2 billion funding required research

and development

$1.32 billion

Funding gap

TAG TB R&D report 2014


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GLOBAL TB

PROGRAMME

Role of Members of Parliament to support theglobal and national vision to END TB

Create national parliamentary groups, fora and caucus to promote the cause inyour country

Ensure support to Ministers of Health in the adoption and adaptation of the new

End TB Strategy and related elimination targets

Advocate for inclusion of TB support and resources in the main national and

international agendas of your country; prioritize high-quality TB care, social

protection and UHC initiatives that are TB-sensitive, and research investments

Establish links with those responsible for the post-2015 global development

agendaand promote specific wording, targets, indicators for TB as part of the

future "sustainable development" goals

Advocate for much increased investmentson TB control and elimination by

financial institutions (e.g., World Bank, Global Fund, UNITAID) to ensure sufficient

international funding in support of the poorest countries


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GLOBAL TB

Many thanks

to all!

Documents

What's New in WHO Policy Guidance