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Developing post-2015 strategy and targets for TB prevention, treatment and care

Developing post-2015 strategy and targets for TB prevention, treatment and care. Dr Malgosia Grzemska Stop TB Department World Health Organization. Aims of presentation. Outline current status of TB care and control Rationale for new TB strategy and targets Proposed frameworks

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Developing post-2015 strategy and targets for TB prevention, treatment and care

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  1. Developing post-2015 strategy and targets for TB prevention, treatment and care Dr Malgosia Grzemska Stop TB Department World Health Organization

  2. Aims of presentation • Outline current status of TB care and control • Rationale for new TB strategy and targets • Proposed frameworks • Process ahead

  3. The Global Burden of TB -2010 Estimated number of cases Estimated number of deaths 8.8 million (range: 8.5–9.2 million) 1.45 million (range: 1.2–1.6 million) All forms of TB 1.1 million (13%) (range: 1.0–1.2 million) 350,000 (range: 320,000–390,000) HIV-associated TB Multidrug-resistant TB (MDR-TB) 440,000 (range: 390,000–510,000) about 150,000

  4. The global response: Stop TB Strategy & Global Plan To save lives, prevent suffering, protect the vulnerable, and promote human rights

  5. Global Progress Incidence • 46 million patients cured, 1995-2010 • 7 million lives saved compared to 1994 care standards • 2015 MDG target on track: global TB incidence rate peaked in 2002, cases in 2006 • BUT, TB incidence declining too slowly and 1.4 million people still dying unnecessarily Rate peaked in 2002 Falling 1.3% per year Cases falling since 2006 1990 2010 Mortality On track to target 40% decline since 1990 1990 2015

  6. Looking beyond 2015: Rationale At the 65th World Health Assembly in May 2012, Member States called upon WHO to develop a new post-2015 TB strategy and targets and present this to Member States at the 67th World Health Assembly in 2014. Some States also urged WHO to start the formal process through the Executive Board and World Health Assembly in 2013.

  7. Moving towards a new approach: Addressing the most vulnerable Poor, crowded & poorly ventilated settings Half a million women and over 70,000 children die of TB each year; 10 million “TB” orphans Migrants, prisoners, minorities, refugees face risks, discrimination & barriers to care TB linked to HIV infection, malnutrition, alcohol, drug and tobacco use, diabetes

  8. Moving towards a new approach:Addressing key challenges Case detection A third of cases not diagnosed/reported TB/HIV co infection Special challenge in Africa Multidrug - resistant TB Special challenge in Eastern Europe Weak health policies, systems, financing, and services Under-engaged communities and providers Bottlenecks for financing of research and innovation

  9. The way forward: Expansion with Innovation

  10. Better defining the drivers of the TB epidemics • “Know your epidemic”! • Improved prioritization of approaches based on: • Social and economic situation • Degree of concentration of the TB epidemic • Key drivers such as HIV, undernutrition, crowding, migration, etc. • Risk factors associated with the “epidemiological transition”.

  11. Types of TB epidemics Pre-elimination: mortality ≤ 1 / 100,000 Concentrated: 1 < mortality < 20 / 100,000 Endemic: mortality ≥ 20 / 100,000 High-MDR: MDR in new > 5% High-HIV: HIV in TB > 20%

  12. DRAFT Proposed Pillars and Principles of the Post-2015 TB Strategy WHO and Partners Support to countries Surveillance, Monitoring and Evaluation Bold Policies and Supportive Systems Intensified Research And Innovation Innovative TB Care Promotion of human rights, ethics and equity Community & civil society engagement; private sector collaboration Government Stewardship and Country Adaptation Sept 2012

  13. DRAFT Post-2015 TB Strategy CORE PRINCIPLES: Government stewardship with adequate financing Engagement of communities and civil society; Collaboration with private sector Promotion of human rights, ethics and equity Adaptation of the strategy and targets at country level Monitoring and evaluation across all strategy components Sept 2012

  14. DRAFTPost-2015 TB Strategy Sept 2012

  15. DRAFTPost-2015 TB Strategy Sept 2012

  16. DRAFTPost-2015 TB Strategy Sept 2012

  17. Defining new targets Rationale Millennium Development Goals set for 2015 • MDG Goal 6, combat HIV/AIDS, malaria and other diseases

  18. Rationale: Defining new targets (2) Stop TB Partnership targets set for 2015 and 2050

  19. Decline in incidence: Different scenarios Current rate of decline 1.3%/year China,Cambodia..- 4%/year Western Europe after WWII-10%/year Elimination target: < 1/million/year- 20%/year

  20. Decline in mortality: Different scenarios

  21. Estimated TB mortality rates, 2010

  22. Moving into a pre-elimination phase * Pre-elimination defined as mortality≤ 1/100,000

  23. Principles for target setting Targets should be • Ambitious • Inspirational • Realistic Progress towards targets should be • Measureable based on a well-defined indicator • Measured and monitored at country level

  24. Many thanks to all

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