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Regional efforts in controlling TB: progress and challenges for future

Regional efforts in controlling TB: progress and challenges for future. 2nd National conference on the national response to TB epidemic: 10 main TB challenges and ways to combat them Kyiv, 13-14 November 2007. Pierpaolo de Colombani Medical Officer WHO-EURO, DHP/CDS/TUB.

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Regional efforts in controlling TB: progress and challenges for future

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  1. Regional efforts in controlling TB: progress and challenges for future 2nd National conference on the national response to TB epidemic: 10 main TB challenges and ways to combat them Kyiv, 13-14 November 2007 Pierpaolo de Colombani Medical Officer WHO-EURO, DHP/CDS/TUB

  2. Regional efforts in controlling TB: progress and challenges for future • Topics: • Overview of TB epidemiology • Progress towards the TB targets • Challenges for TB control in EEUR • Opportunities for TB control in EEUR

  3. Estimated TB burden; world, 2005 8.8 million new TB cases (>80% in Asia and sub-Saharan Africa) 1.6 million TB deaths (195 000 due to TB/HIV) TB incidence stable or in decline in all six WHO regions 424 000 MDR-TB cases (MDR-TB in 102 of 109 countries surveyed in 1994-2002) 27 000 XDR-TB cases

  4. Estimated number of TB cases; world, 2005 Estimated number of new TB cases (all forms) No estimate 0–999 1000–9999 10 000–99 999 100 000–999 999 1 000 000 or more WHO. Global tuberculosis control: surveillance, planning, financing; WHO report 2007. Geneva: WHO (WHO/HTM/TB/2007.376)

  5. TB cases (all) per 100,000 pop. < 10 10-24 25-74 75-124 125-198 Estimated incidence of TB; EUR, 2005 50 / 100 000 average in the region 5 - 198 / 100 000 range Norway - Tajikistan 445,000 number of new TB cases 66,000 number of deaths due to TB WHO. Global tuberculosis control: surveillance, planning, financing; WHO report 2007. Geneva: WHO (WHO/HTM/TB/2007.376)

  6. Trend in notification of TB; EUR, 1980-2005

  7. TB burden and priority for action; EUR, 2005 Number of new estimated TB cases indicated by the size of the bubble 170 000 46 000 WHO. Global tuberculosis control: surveillance, planning, financing; WHO report 2007. Geneva: WHO (WHO/HTM/TB/2007.376)

  8. The global targets for TB control By 2015(Millennium Development Goals) Goal 6: combat HIV/AIDS, malaria and other diseases Target 8: to halt and begin to reverse the incidence of malaria and other major diseases (such as TB) Indicator 23: prevalence and mortality associated with TB Indicator 24: detection and cure of TB cases under DOTS Impact By 2015 (Stop TB Partnership targets) Prevalence and mortality associated with TB reduced of 50% By 2005 (World Health Assembly targets) - Detection of at least 70% of infectious TB cases - Cure (successful treatment) of at least 85% of detected cases Outcome

  9. Progress on MDG 6 (1 of 2) TB incidence rate per 100 000 population  TB prevalence rate per 100 000 population TB death rate per 100 000 population

  10. Progress on MDG 6 (2 of 2) WHO. Global tuberculosis control: surveillance, planning, financing; WHO report 2007. Geneva: WHO (WHO/HTM/TB/2007.376)

  11. Challenges and opportunities for TB control; EEUR

  12. Population living with DOTS (%) no Stop TB Strategy < 10 10 - 49 50 - 99 100 Population living in areas with DOTS; EUR, 2005 Note: 100% population coverage by the Stop TB Strategy in 2007 in Russian Federation and Ukraine.

  13. Top 14 sites MDR-TB (all cases); world, 2004 Estimated ~ 70,000 MDR-TB cases in EUR Zignol M, Hosseini MS, Wright A et al. Global incidence of multidrug-resistant tuberculosis. JID 2006, 194:479-485.

  14. Countries with confirmed XDR-TB; world, October 2007 Estimated ~ 10,000 XDR-TB cases in EUR Source: http://www.who.int/tb/xdr/en/index.html (access 9 Oct 2007)

  15. Unsuccessful TB treatment outcome; WHO region, 2004 DOTS Non - DOTS WHO. Global tuberculosis control: surveillance, planning, financing; WHO report 2007. Geneva: WHO (WHO/HTM/TB/2007.376)

  16. New HIV cases notified by EUR area, 1995-04

  17. HIV prevalence in TB cases (%) no information <1 1-5 5-10 >10 HIV prevalence among new adult TB cases; EUR, 2005 • HIV prevalence in TB cases with 4.6% regional average • Lack of good, reliable and country-wide information • Limited collaboration between HIV and TB programmes • Different patterns and type of co-infection in W and E • Lack of community and activists involvement

  18. Inadequate health systems leading to inequitable access to health services; EUR, 2003 Out-of-pocket (OOPS) spending increasing with decreasing of public spending on health, used as proxy of inadequate health care services Source: WHO/EURO, Kutzin J.

  19. Top 20 countries with highest prison population rate; world, 1998-05 6 countries from EUR Walmsley R. World Prison Population List, 6th Ed.; 2005. London King’s College, International Centre for prison Studies (http://www.kcl.ac.uk/depsta/rel/icps/world-prison-population-list-2005.pdf)

  20. The Berlin Declaration on tuberculosis • Berlin, 22 October 2007 • 49 country delegations • Commitment to: - strengthen TB control - adopt the Stop TB Strategy - ensure sustainable financing

  21. The Stop TB Strategy • Pursue high-quality DOTS expansion and enhancement(political commitment, quality bacteriology, guaranteed treatment, ensured drug supply, monitoring and evaluation) • Address TB-HIV, MDR-TB and other challenges(prisoners, other risk groups) • Contribute to health system strengthening • Engage all care providers(public-private, international standards) • Empower patients and communities(ACSM, community participation, patients’ charter) • Enable and promote research

  22. The Stop TB Strategy: International Standards for TB Care

  23. The Stop TB Strategy: The Patients’ Charter for TB Care

  24. Plan to Stop TB in 18 high-priority countries of the WHO European Region, 2007-2015 US$ billion Needed 14.8 Available 6.7 Gap 8 (i.e. 1- 3.1 US$ per person by governments)

  25. Global Fund funds increasing for TB control; EUR, 2002-06 US$ million

  26. Health systems: merging interests with Stop TB Health system Stop TB DOTS (political commitment, quality bacteriology, guaranteed treatment, ensured drug supply, monitoring and evaluation) Leadership and governance Financing TB/HIV, MDR-TB, etc. Health work force Health system strengthening Medical products and commodities Engage all providers Empower patients and communities Information Service delivery Research

  27. Health systems: opportunities for TB delivery at PHC level • Suspect TB and react quickly • Collect 3 sputum samples from each suspect • Smear samples and/or send samples to designed laboratory for microscopy • Refer TB suspects for early TB diagnosis • Provide directly observed treatment (DOT) • Coordinate support to TB patients • Trace treatment defaulters • Refer patients with adverse drug reactions • Keep TB records and reporting • Monitor populations at special risk of TB • Educate patients, families, community • Check TB contacts (symptoms, skin testing) • Provide BCG vaccination

  28. Health systems: reform leading to improved TB control TARGET Kyrgyzstan: Manas Taalimi Reform, phase II (2001-2006) Note: progress in new sputum smear-positive cases under DOTS

  29. Stop TB Partnership for Europe

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