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  1. Thank you for viewing this presentation. • We would like to remind you that this material is the property of the author.It is provided to you by the ERS for your personal use only, as submitted by the author. • 2012 by the author

  2. Control of MDR-/XDR-TB and elimination of TB in Europe: status update Dr Masoud Dara Programme Manager TB and M/XDR-TB WHO Regional Office for Europe

  3. I have no, real or perceived, conflicts of interest that relate to this presentation.

  4. Outline of presentation • An overview of TB and M/XDR-TB situation • Global and European Response • Current status of TB care and control • Progress so far • Process ahead

  5. Estimated TB burden; world, 2010 www.worldmapper.org 8.8 million in the world 420 000 in Europe Global tuberculosis control: WHO report 2011. Geneva: WHO, 2011 (WHO/HTM/TB/2011.16)

  6. Burden of TB in WHO Europe, 2010 • Main figures • 420,000 new TB cases per year (47 per 100,000 pop, <1 – 206 in Monaco – Tajikistan) • 81,000 (73-90,000) MDR-TB cases • 60,000 (48-75,000) deaths • Incidence peak in 2000, then falling by 2% per year; MDG target on track • Prevalence falling, MDG target not on track • Mortality falling, MDG target on track 18 high priority countries: Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Romania, Russian Fed, Tajikistan, Turkey, Turkmenistan, Ukraine, Uzbekistan Global tuberculosis control: WHO report 2011. Geneva: WHO, 2011 (WHO/HTM/TB/2011.16)

  7. Global Progress • 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 Mortality 1990 2010 On track to target 40% decline since 1990 1990 2015

  8. Percentages of notified MDR among TB cases, WHO European Region, 2005-2010

  9. MDR-TB Rates Belarus; DRS finalized recently: New: 32.3% (95% CI:29.7-35%) Previously treated: 75.6% (72.1-78.9%)

  10. Percentages of TB cases with HIV infection among all TB cases tested to HIV, WHO European Region, 2006-2010 increasing by 20% per year in the last 5 years

  11. Percentages of notified TB cases of foreign origin among all TB cases, WHO European Region, 2010 Determinants of TB TB is particularly linked to migration, and imprisonment Identification of the geographic origin of patients was significantly better in western countries Identification of the imprisonment status of patients was significantly better in eastern countries Overall TB notification rate (all TB) per 100,000 inmates, the WHO European Region, 2010 Average = 280/100000

  12. Treatment outcome by WHO Region, 2010 reporting year WHO European Region Other WHO Regions 12

  13. Treatment outcome, new laboratory-confirmed pulmonary TB cases, European Region, 2001 - 2009

  14. Children with TB, WHO European Region, 2010 About 10 000 children with TB one dot = one child

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

  16. European Response • Berlin Declaration • EU and WHO EURO action plans for TB and MDR-TB control • EU and WHO EURO monitoring frameworks

  17. Key challenges in prevention and control of M/XDR-TB • Health system failure to prevent emergence and spread of drug resistance TB • Late diagnosis of TB and M/XDR-TB • Inadequate treatment of TB and subsequent acquired resistance • Poor infection control and contact tracing • Insufficient capacity to treat M/XDR-TB patients • Models of care not cost effective, nor patient friendly • Difficult access to expensive second line drugs • Lack of new medicines

  18. Consolidated action plan to prevent and combat M/XDR-TB, 2011-2015 Goal : To contain the spread of drug resistant tuberculosis by achieving Universal Access to prevention, diagnosis and treatment of M/XDR-TB in all Member States of the WHO European Region by 2015 18

  19. Targets MDR Action Plan 2011-15 Targets: • To decrease by 20 percentage points MDR-TB proportion among previously treated patients by end 2015 • To diagnose at least 85% of estimated MDR-TB patients by 2015 • To successfully treat at least 75% of estimated number of patients suffering from MDR-TB by 2015

  20. What is new in MAP? • Prompt diagnosis including newly endorsed molecular diagnostic techniques • Equitable Access to adequate treatment • Health System approach to MDR-TB prevention and control • Emphasis on involvement of civil society organization • Identifying and addressing social determinants • Working in partnership, twinning of cities/programmes • Robust monitoring framework, accountability and follow-up • Promoting development of new drugs and tools

  21. Expected Achievement of MAP 225 000 MDR-TB patients diagnosed 127 000 MDR-TB patients treated successfully; 250 000 MDR-TB cases averted; 13 000 XDR-TB cases averted; 120 000 lives saved; and 7 billion US $ is saved by averting further emergence of M/XDR-TB

  22. Monitoring of MDR-TB, European Region Target by 2015 85% Close to 100% 75% • 36% MDR-TB detection rate among all emerging • 96% MDR-TB treatment enrolment • 56% treatment success

  23. Joint launch of the MDR Action Plan, 2011 High level MDG6 Forum October 2011, Moscow 23

  24. Regional Committee resolution on M/XDR-TB Adopts the Consolidated Action Plan and Urges Member States: • to harmonize as appropriate their national health strategies and/or TB/MDR-TB response plans based on the Regional Plan • to Identify and address determinants and health system challenges leading to emergence of drug resistant TB • to provide universal access to early diagnosis and effective treatment of MDR-TB patients • to address the needs of special population • to closely monitor and evaluate implementation of the actions outlined in the Action Plan • Requests the Regional Director: • to provide leadership, strategic direction and technical support for implementation of the Action Plan • to facilitate the exchange of experiences and know-how among the Member States • to establish a platform to strengthen partnership for prevention and control of TB and M/XDR-TB • to assess progress in the prevention and control of M/XDR-TB every other year starting from 2013 and report back to the Regional Committee Primary Health Care, Psycho-social Support, Health Financing

  25. Achievements after launch of MAP • Eight countries (Armenia, Azerbaijan, Estonia, Georgia, Latvia, Switzerland, Ukraine and Uzbekistan) have adopted their National Plans to MAP • Other countries are updating their plans with WHO and partners’ assistance • EU parliamentarian hearing organized on World TB Day to brief MPs on M/XDR-TB • 36 technical assistance mission on infection control, M/XDR-TB clinical, laboratory and programmatic management organized • The second line drug forecasting and procurement supply and management elaborated in 18 high priority countries (workshop with GFATM, GLC/Europe and GDF organised) report available • HUN, KAZ and AZE programme reviews organized • Task Force on HS and MDR-TB established • European TB Laboratory Initiative established • Regional TB Interagency Coordination Committee is being established to oversee implementation of MAP

  26. 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.

  27. Thank you very much for your attention With thanks to • All 53 Member States • Colleagues from WHO/Europe and WHO headquarters Pictures by Misha Friedman, winner of the 2010 Images to Stop TB Award, who travelled to Donestk, Ukraine, to capture difficult but moving instants in the daily lives of people ill with TB and those who care for them. www.euro.who.int/tb tuberculosis@euro.who.int

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