world tb day 2017 - presentation
TRANSCRIPT
World TB Day 2017
TB/HIV co-infections soaring across Europe in five years
© Carl Cordonnier © Maxim Dondiuk© Andrei Dadu
Some good news across the board
Key progress:• full-scale programmes• fewer new TB cases per year• more people treated successfully• more drug-resistant patients diagnosed• almost all drug-resistant patients put on
treatment• increase in MDR-TB treatment-success
rate
Key indicators 2011 2015
Approach to drug-resistant TBSmall-scale
pilot projects
Nationwide integrated
programmes
TB notification rate/100 000 40 36Drug-susceptible success rate (%) 72 76MDR-TB detection rate (%) 30 63
MDR-TB treatment coverage (%) 63 Universal coverage
MDR-TB success rate (%) 48 51
Source: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.
TB deaths are decreasing
20002002
20042006
20082010
20122014
20162018
20200
2
4
6
8
10
3.52.7
Estimated TB mortality rate Projection 2016-2020
Rate
per
100
000
pop
ulati
on
–8.5% yearly in TB deaths between 2011 and 2015
If current trend continues, the targeted death rate of
2.7/100 000 will be achieved by 2018
on trackSource: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.
New TB cases are decreasing
19901992
19941996
19982000
20022004
20062008
20102012
20142016
20182020
0
10
20
30
40
50
29.224.6
Notification rate (all countries)Projected if current trends continuesTarget
Rate
per
100
000
pop
ulati
on –4.7% yearly in new TB cases between 2011 and 2015
If current trend continues, the targeted
notification rate of 24.6/100 000 will be achieved by 2019
on trackSource: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
0
1
2
3
4
5
6
7
8
9
10
3.6
0.54
Estimated TB/HIV mortality rate Estimated TB mortality rate
Rate
per
100
000
pop
ulati
on
3.6% annual increase between 2011
and 2015
–8.5% yearly between 2011 and 2015
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
0
10
20
30
40
50
60
70
80
3
36
Estimated TB/HIV rate Estimated TB incidence rate
Rate
per
100
000
pop
ulati
on
–4.3% yearly between 2011 and 2015
6.2% annual increase between 2011 and
2015
TB deaths and new cases going down:TB/HIV deaths and new TB/HIV cases rising sharply
TB and TB/HIV mortality, WHO European Region, 2000–2015
TB and TB/HIV incidence, WHO European Region, 2000–2015
Source: 1. Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe. 2. Global TB report 2016. WHO
Improved treatment success in all TB patient groups except for those who are HIV positive
Treatment-success rates were raised to 76% and 51% in new and MDR-TB cohorts respectively, a remarkable turning point for the WHO European Region, which has seen a decline since the beginning of the millennium.
Treatment outcomes, WHO European Region, 2011 data
New TB/HIV MDR-TB
6753 49
Treatment outcomes, WHO European Region, 2015 data
New TB/HIV MDR-TB
76
4151
Not evaluatedLost to follow-upFailedDiedSuccess
Source: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.
No reason for complacency
323 000 peopleIN WHO EUROPEAN REGION FELL ILL LAST YEAR FROM TB
32 000 people
DIE FROM TB
Every 15 minutes
Source: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.
TB can affect anybody at any time,but some people are more affected than others
New TB cases per 100 000 population, WHO European Region, 2015
Source: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.
Who are tuberculosis patients?
Of the estimated 323 000 new TB patients in 2015 in WHO European Region:
25 000
are children
111 000 are females190 000
are males
8%
34%
58%
Source: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.
0–4 years
5–14 years
15–24 years
25–44 years
46–64 years
over 64 years
1%
3%
11%
45%
29%
11%
TB cases by age groups, %, WHO European Region, 2015
Almost one in two TB patients is an adult
Source: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.
Dr Zsuzsanna JakabWHO Regional Director for Europe
The flare-up of TB/HIV co-infections from 2011 to 2015, together with persistently high rates of drug-
resistant TB, seriously threaten progress made towards TB elimination that European and world
leaders have committed to achieve by 2030.
One in three people co-infected with TB/HIV does not know about their status, which drastically
lowers their chances of being cured. In turn, this favours the spread of the diseases, putting health
systems and governments under pressure.
TB/HIV co-infection has soared in Europe in five years
HIV and TB create a deadly synergy
Between 2011 and 2015, the percentage of TB/HIV co-infection
rose from 5.5% to 9%2011 2012 2013 2014 2015
0
20
40
60
80
100
0.0
2.0
4.0
6.0
8.0
10.0
5.56.1
7.8 8.09.0
71.377.9
85.9 88.9 88.0
HIV testing coverage and percentage of HIV positive among TB patients, WHO European Region, 2011–
2015
Percentage of HIV among TB HIV testing coverage
% %
Source: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.
HIV and TB create a deadly combination• About 88% HIV testing coverage among 230 000
new TB cases and relapses
• 61% of 27 000 estimated TB/HIV cases were detected
• Of which only 5 818 (36%) were offered antiretroviral treatment (ART)
• Treatment success of 41% is the lowest ever
HIV testing coverage
TB/HIV case detection
ART coverage Treatment succes
88%
61%
36% 41%
Cascade analysis of TB/HIV case detection, ART coverage and outcomes*, WHO European Region, 2015
* No data from RUS,otherwise 64% No data from RUS
Source: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.
14
People with TB/HIV are seven times at higher risk of failing treatment and three times at higher risk of dying than people with TB disease
Success Died Failed Lost-to-follow up Not evaluated
77%
7% 4% 5% 7%
41%
21%28%
7% 3%
HIV negativeHIV positive
Treatment outcomes of new TB and relapses by HIV status, WHO European Region, 2015
Source: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.
Europe’s TB burden is among the lowest in the world, but the number of new MDR-TB cases is the highest
AFR
AMR
EMR
EUR-
53
EUR-
18HP
C
SEAR
WPR
Glob
al0
50
100
150
200
250
300275
27
116
36
65
246
86
142
TB incidence, WHO regions, 2015
per 1
00 0
00 p
opul
ation
AFR
AMR
EMR
EUR-
53
EUR-
18HP
C
SEAR
WPR
Glob
al
-
5
10
15
20
25
30
35
11.0
1.1
6.0
14.0
31.4
10.0
5.57.9
MDR-TB incidence, WHO regions, 2015
per 1
00 0
00 p
opul
ation
Source: 1. Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe. 2. Global TB report 2016. WHO
Tajikis
tan
Belarus
Rep Mold
ova
Uzbek
istan
Ukraine
Kyrgyzs
tan
Russian
Federa
tion
Somalia
Kazak
hstan
Azerbaij
anPeru
WHO Europe
World
0
25
50
75
100
7769 69
63 58 56 5347 43
2921
48
2114
37 3224 25
3222
9
2513
616
4
Percentage of MDR-TB among re-treatmentsPercentage of MDR-TB among new cases
Perc
enta
ge o
f MDR
-TB
MDR-TB in new TB cases occurs four times more often in Europe than in the rest of the world
Source: 1. Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe. 2. Global TB report 2016. WHO
74 000 drug-resistant TB cases in WHO European Region, 2015
43 000 (60%) drug-resistant TB cases detected and enrolled on treatment, 2015
21 800 (51%) drug-resistant TB cases started treatment in 2013 with successful outcome
Only about 60% of MDR-TB patients are detected
Source: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.
MDR-TB is one of key drivers of the TB epidemic in Europe
a r e f o u n d w i t h MDR TURBERCULOSIS
EVERY 6TH NEW TB PATIENT EVERY 2ND PREVIOUSLY TB PATIENT
Source: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.
For the first time, more MDR-TB patients were successfully treated in 2015, but new cases continue to rise
2011 2015
14%18%
48%52%
MDR-TB in new cases
MDR-TB treatment success rate
Source: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.
In 2015, about one in four MDR-TB patients had XDR-TB
XDR-TB is more difficult to treat than MDR-TB
Extensively drug-resistant TB is on the rise
2011 2012 2013 2014 2015
12%9%
13%
18%
23%Percentage of XDR-TB among detected MDR-TB cases,
WHO European Region, 2015
Source: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.
Prioritized country work
We are:– building better capacity, including on early diagnosis and treatment of
TB patients
– expanding pilot projects on good TB practice to be adapted to other settings
– scaling-up innovative tools on e- and digital health to improve TB surveillance and monitoring and person-centred service delivery
– strengthening collaborations with partners, including civil society organizations, for holistic TB prevention and care.
What countries need to act upon The TB Action Plan for Europe, 2016–2020Vision: an end to the TB epidemic with zero affected families facing
catastrophic costs due to TBGoal: to stop the spread of drug-susceptible and drug-resistant TB by achieving universal access to prevention,
diagnosis and treatment in all Member States of the WHO European Region
Targets:35% reduction in TB deaths
25% reduction in TB incidence rate75% treatment success rate among the MDR-TB patient
cohort
Key strategic directions
1. Full scale-up of rapid diagnosis
2. Rapid uptake of new medicines
3. Expanding patient- and person-centred care
4. Shorter and more effective treatment regimens
5. Research for new tools
6. Intersectoral approach to address inequities
The way forward
1. Intensify country work (diagnosis, treatment and care with a focus on TB/HIV co-infection through integrated TB/HIV health services)
2. Boost exchange of good practices
3. Scale-up research and innovation
4. Foster full implementation of national action plans
5. Scale-up to full functioning of regional platforms and initiatives
6. Improve preventive treatment (that is, of latent TB infection), scale-up shorter regimen and rational use of new medicines
7. Continue policy dialogue
8. Present progress report at 68th session of WHO Regional Committee for Europe
World TB Day 2017
Thank youwww.euro.who.int/tb
© Carl Cordonnier © Maxim Dondiuk© Andrei Dadu