global targets for tb and hiv: where are we in the ... · hiv targets in the eu/eea ecdc. continuum...
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Global targets for TB and HIV: Where are we in the European Union?
Marieke J. van der Werf
Wolfheze Workshops, The Hague, 15 May 2019
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Sustainable Development Goals and communicable diseases
Source: www.un.org/sustainabledevelopment/health 2
Goal 3. Ensure healthy lives and promote well-being for all at all ages
3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
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WHO End TB Strategy targets
By 2030 compared with 2015
• 90% reduction in number of TB deaths
• 80% reduction in TB incidence rate
• 0% TB-affected families facing catastrophic costs due to TB
Source: World Health Organization, End TB Strategy, A67/11 – 14 March 2014 3
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Progress towards the TB targets, EU/EEA, 2008-2017
Source: Merk et al. Eurosurveillance 2019 4
1
10
100
2008 2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030
Case
s /
100 0
00
80% reduction
TB notification rate
1
10
100
1,000
10,000
2008 2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030
Num
ber
of
TB d
eath
s
Number of TB deaths
90% reduction
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Progress towards the TB targets, EU/EEA
TB-affected families facing catastrophic costs due to TB
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United Nations High Level Meeting political declaration on TB
6
To diagnose and successfully treat 40 million TB cases, including
• 3.5 million children with TB
• 1.5 million people with drug-resistant TB
and
To prevent tuberculosis by provision of preventive treatment
to 30 million people
by 2022
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Country level targets proposed by the Stop TB Partnership
Country TB MDR TB Childhood TB
Austria 600 4 34
Belgium 1 100 9 66
Bulgaria 1 500 26 100
Croatia 400 0 8
Cyprus 52 0 3
Czech Republic 500 4 14
Denmark 300 0 13
Estonia 200 33 5
Finland 200 5 8
France 5 100 79 300
Germany 6 000 0 300
Greece 400 0 23
Hungary 600 16 10
Iceland 16 0 0
Ireland 300 4 12
Italy 4 300 0 200
Latvia 500 25 12
Lithuania 1 400 256 55
Luxembourg 33 1 2
Malta 45 0 0
Netherlands 800 11 39
Norway 200 10 19
Poland 5 800 44 100
Portugal 1 800 10 54
Romania 12 500 384 600
Slovakia 200 7 45
Slovenia 100 0 4
Spain 4 500 0 300
Sweden 500 10 28
United Kingdom 5 300 48 200
Total EU/EEA 55 246 986 2 554http://www.stoptb.org/global/advocacy/unhlm_targets.asp 7
Number of cases to be successfully treated in 2018
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TB cases diagnosed and successfully treated, EU/EEA
8
0
10,000
20,000
30,000
40,000
50,000
60,000
2016 2017 2018 2019 2020 2021 2022
Num
ber
of
TB c
ase
s
Target: Successfully treated
Diagnosed
Successfully treated
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018–2016 data
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TB preventive treatment
Preventive treatment coverage of childhood TB contacts aged under five years
- 3 EU/EEA Member States reporting in 2017
- 47.9% coverage
9Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018–2016 data
Global target 30 million people
No country level targets for low burden higher income countries
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UNAIDS targets for ‘ending the AIDS epidemic’
Source: (UNAIDS 2015). On the Fast-Track to end AIDS. UNAIDS 2016-2021 Strategy 10
By 2020(Fast-track targets)
By 2030(SDG targets)
√ To reduce new HIV infections to fewer than 500 000 by 2020
√ Zero new infections
√ To reduce AIDS-related death to fewer than 500 000 by 2020
√ Zero AIDS deaths
√ To eliminate HIV-related stigma and discrimination by 2020
√ Zero discrimination
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Are we on track to end AIDS?
Source: UNAIDS 2018, ECDC/WHO, HIV Surveillance in Europe 2018, 2017 data 11
0
5000
10000
15000
20000
25000
30000
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Esti
mat
ed n
ew H
IV in
fect
ion
s
EU/EEA estimated infections 2020 target, EU/EEA
23,000
6,000
TARGET: 75% reduction in new
infections by 2020 (baseline 2014)
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UNAIDS targets
By 2020
12
Target 1 Target 2 Target 3
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Progress toward achieving the 1st 90:90% of all PLHIV who know their status (n=23)
Source: ECDC. Dublin Declaration monitoring 2018; Brown et al Eurosurveillance 2018.Latest available data reported, ranging from 2014-2017.
13
Target reached within 10% of target >10% from target
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Global target 90%
EU/EEA 87%
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Progress toward achieving the 2nd 90:90% of those diagnosed on ART (n=22)
Source: ECDC. Dublin Declaration monitoring 2018; Brown et al Eurosurveillance 2018.Latest available data reported, ranging from 2014-2017.
14
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Target reached >10% from target
Global target 90%
Overall EU/EEA 91%
within 10% of target
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Progress toward achieving the 3rd 90:90% of those on ART virally suppressed (n=20)
Source: ECDC. Dublin Declaration monitoring 2018; Brown et al Eurosurveillance 2018.Latest available data reported, ranging from 2014-2017.
15
Target reached within 10% of target >10% from target
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Global target 90%
EU/EEA 92%
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Summary: Progress toward achieving the 90-90-90 HIV targets in the EU/EEA
ECDC. Continuum of HIV care. Monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia: 2018 progress report. Stockholm: ECDC; 2018 16
100%
87%
79%
73%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PLHIV Diagnosed On treatment Virally suppressed
90%
81%
73%
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Conclusions
Monitoring
• Some targets are not measured in the EU/EEA
➢ % TB-affected families facing catastrophic costs due to TB
➢ HIV-related stigma and discrimination
• Not all Member States report on all targets
17
Tuberculosis
The EU is not on track to reach the SDG targets of 80% reduction in TB incidence and 90% reduction in number of TB deaths
Targets for diagnosis and successfully treated can be reached
HIV/AIDS
The EU is not on track to meet the SDG target of 75% fewer infections
90-90-90 targets can be reached
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Acknowledgements
ECDC HIV STD and hepatitis programme staff
ECDC TB programme staff
Nominated operational contact points for HIV and TB surveillance from European Union/European
Economic Area (EU/EEA) Member States
18