The TB situation in the The TB situation in the Americas:Americas:

Reaching the MDGs on TBReaching the MDGs on TB

Dr. Jarbas BarbosaArea Manager, Health Surveillance & Disease Management

23 March 2007

Estimated TB Incidence Rates, 2005

No estimate

0–24

50–99

100–299

300 or more

25–49

Estimated New TB cases (all forms) per 100,000 inhabitants

Estimated TB Incidence Rates, 2005

0

50

100

150

200

250

300

350H

ait

í

Bo

livia

Pe

ru

Gu

ya

na

Ec

ua

do

r

Do

min

ica

n R

ep

.

Gu

ate

ma

la

Ho

nd

ura

s

Pa

rag

ua

y

Su

rin

am

e

Bra

zil

Nic

ara

gu

a

El S

alv

ad

or

Co

lom

bia

Pa

na

ma

Arg

en

tin

a

Ve

ne

zue

la

RE

GIO

N

Uru

gu

ay

Me

xic

o

Ch

ile

Co

sta

Ric

a

Cu

ba

US

A

Ca

na

da

Estimates

Notifications

Cas

es x

100

.000

Source: Global Tuberculosis Control. WHO Report 2007.

Tuberculosis Notification Rates, 2005

0

50

100

150

200

250

300

350

Ha

iti

Bo

livia

Pe

ru

Gu

ya

na

Ec

ua

do

r

Do

min

ica

n R

ep

.

Gu

ate

ma

la

Ho

nd

ura

s

Pa

rag

ua

y

Su

rin

am

e

Bra

zil

Nic

ara

gu

a

El S

alv

ad

or

Co

lom

bia

Pa

na

ma

Arg

en

tin

a

Ve

ne

zue

la

RE

GIO

N

Uru

gu

ay

Me

xic

o

Ch

ile

Co

sta

Ric

a

Cu

ba

US

A

Ca

na

da

Estimates

Notifications

Cas

es x

100

.000

Source: Global Tuberculosis Control. WHO Report 2007.

Reported New TB Cases, Americas, 2005

80%80%

HaitiHaiti

Dom. Rep.Dom. Rep.

MexicoMexico

HondurasHonduras

EcuadorEcuador

Peru Peru

Bolivia Bolivia

BrazilBrazil

NicaraguaNicaragua

GuyanaGuyana

ColombiaColombia

GuatemalaGuatemala

PeruPeru

BrazilBrazil

50% 50%

Total: 227.659

Source: Global Tuberculosis Control. WHO Report 2007.

Reported TB Incidence Rates, Americas, 2005

0

5

10

15

20

25

30

35

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2626

14 14

TBP BK+

TB all forms

Case

s per

100

00

0 h

ab.

Source: Global Tuberculosis Control. WHO Report 2007.

DOTS Coverage, Americas, 2005

<50%

≥50-89%

≥ 90%

without DOTS

2005 DOTS

Coverage:

88%88% of the population

Source: Global Tuberculosis Control. WHO Report 2007.

Challenges in Challenges in Tuberculosis Control:Tuberculosis Control:

TB/HIVTB/HIV

HIV Prevalence in Adults in Latin America and the Caribbean, 1990−2005

Source: UNAIDS, 2006

Estimated HIV Prevalence in New TB Cases, 2005

No estimate

0–4

20–49

50 or more

5–19

HIV prevalence in TB cases, age 15–49 (%)

Countries in the American Region Testing Tuberculosis Patients for HIV, 2005

No reported activity

< 15%

15% to 25%

25% to 50%

More than 50%

Proportion of TB Patients Tested

for HIV: Key

5 =5 =

==

55

555555 555555

5555

5555

55

55

Countries with generalised HIV epidemic, 2004;Countries with generalised HIV epidemic, 2004; HIV testing recommended for all TB patients HIV testing recommended for all TB patients

Countries with a high estimated TB/HIV casesCountries with a high estimated TB/HIV casesbut not a generalized HIV epidemicbut not a generalized HIV epidemic

0

5

10

15

20

25

30

35

HIV Prevalence in Adult Patients with TB, Americas, 2005

WHO estimate

Notified by countries

Source: Global Tuberculosis Control. WHO Report 2007.

Challenges in Tuberculosis Challenges in Tuberculosis Control:Control:

MDR-TB and XDR-TBMDR-TB and XDR-TB

Prevalence of Initial MDR-TB, 1994–2005

0 - 0,9%

1,0 -1,9%

2,0 - 2,9%

> 3%

Source: WHO Report 2006. Global Tuberculosis Control

Countries Reporting at Least One Case of XDR-TB

Preliminary Information:

XDR-TB has been identified in 7 countries in the Americas

Percentage of National TB Programs (NTPs) That Manage MDR-TB Patients as Part of Their Routine Activities,

by WHO Region, 2005

0%

20%

40%

60%

80%

100%

AFR AMR EMR EUR SEAR WPR Global

Source: Global Tuberculosis Control. WHO Report 2007.

Will we reach the targets for global TB control?

MILLENNIUM DEVELOPMENT GOALS:"to have halted and begun to reverse

incidence.." Implementation (DOTS) Target year

Case detection 70% 2005Treatment success 85% 2004/5

ImpactPrevalence 50% of ≈ 99/100K 2015Deaths 50% of ≈ 10/100K 2015Incidence <1 per million 2050

0102030405060708090

Success Tx Case detec. Rate

%

year

65%

80%

Did we Reach the 2005 targets?

Source: Global Tuberculosis Control. WHO Report 2007.

Did we reach the 2005 targets? No, but… 65/70 + 80/85 = We are near

Incidence has begun to decrease

88% of the population live in DOTS areas

79% of the cases are notified under DOTS

Countries are implementing:

• the “Interim TB/HIV Policy”

• the GLC projects

• Plans to reach "neglected populations”

“STOP TB Partnerships” are being launched in the countries

Will we reach the Will we reach the Millennium Development Objectives Millennium Development Objectives

by 2015? by 2015?

Estimated TB Prevalence (a) and Death Rates (b), by WHO Region, for the MDG Baseline Year 1990, for 2005,

and as Compared with the MDG Target for 2015

0

100

200

300

400

500

600

AFR AMR EMR EUR SEAR WPR World

1990 2005 Target

0

20

40

60

80

100

AFR AMR EMR EUR SEAR WPR World

1990 2005 Target

(a) TB prevalence rate per 100 000 population (b) TB death rate per 100 000 population

Source: Global Tuberculosis Control. WHO Report 2007.

• Will we reach the goals of the Will we reach the goals of the Millennium Objectives?? Millennium Objectives??

YES, BUT ONLY IF…YES, BUT ONLY IF…The Global and Regional Plans become The Global and Regional Plans become

solid and financed national plans that solid and financed national plans that implement the new “Stop TB Strategy”implement the new “Stop TB Strategy”

There is intense Supervision and There is intense Supervision and Monitoring to guide the actions and Monitoring to guide the actions and evaluate the impact. evaluate the impact.

Thank you