Informal consultation on MDR-TB, health systems and social

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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
I have no, real or perceived, conflicts of interest
that relate to this presentation.
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
4
Estimated TB burden; world, 2010
www.worldmapper.org
8.8 million in the world
420 000 in Europe
Western
Pacific
19%
SE Asia
40%
Africa
26%
Europe
5%
Americas
3%
East
Mediterra
nean
7%
Global tuberculosis control: WHO report 2011. Geneva: WHO, 2011 (WHO/HTM/TB/2011.16)
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
Global tuberculosis control: WHO report 2011. Geneva: WHO,
2011 (WHO/HTM/TB/2011.16)
18 high priority countries: Armenia, Azerbaijan,
Belarus, Bulgaria, Estonia, Georgia, Kazakhstan,
Kyrgyzstan, Latvia, Lithuania, Moldova, Romania,
Russian Fed, Tajikistan, Turkey, Turkmenistan,
Ukraine, Uzbekistan
6
Global Progress
• 46 million patients cured, 1995-2010
Rate peaked in 2002
• 7 million lives saved compared to 1994
care standards
Falling 1.3% per year
Cases falling since 2006
1990
2010
Mortality
• 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
On track to target
40% decline since 1990
1990
2015
Percentages of notified MDR among TB cases,
WHO European Region, 2005-2010
60%
48.2%
50%
40%
30%
24.4%
20%
13.7%
10%
3.9%
0%
2005
2006
2007
2008
New
Retreatment
Log. (New)
Log. (Retreatment)
2009
2010
8
MDR-TB Rates
65.1
61.6 60.2
Previously TB treated cases
55.8
51.5
49
New TB cases
45.6 45.1 44.3 44.3
43.2
41.9
39
30.6
25.7
19.4
24.2 23.5
22.3
16.5
10.6
14.2
17.5
18.3
14.2
16.0
14.3
9.4
10.3
9.5
2.0
21
13.3
3.3
Belarus; DRS finalized recently: New: 32.3% (95%
CI:29.7-35%) Previously treated: 75.6% (72.1-78.9%)
9
Percentages of TB cases with HIV infection among all TB cases
tested to HIV, WHO European Region, 2006-2010
%
6
increasing by 20% per year
in the last 5 years
5.5
4.8
5
4
3
3.6
2.8
2.8
2006
2007
2
1
0
2008
2009
2010
10
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
Treatment outcome by WHO Region,
2010 reporting year
WHO European Region
Other WHO Regions
100%
7
90%
80%
6
1
6
1
5
2
4
3
10
5
1
3
3
1
1
2
4.3
6.1
7.3
6.7
11.3
14.1
8
11.3
1
5
9.0
23.7
70%
13.0
93
88
88
60%
80
9.3
76
68.7
11.3
50%
56.3
47.6
40%
AFR
AMR
Not evaluated
EMR
SEAR
Defaulted
New pulmonary
lab.confirmed
WPR
Failed
Died
12
Re-treated
lab confirmed
Successfully treated
MDR-TB cohort
Treatment outcome, new laboratoryconfirmed pulmonary TB cases, European
Region, 2001 - 2009
25
%
76.0
75.0
74.4
74.0
20
73.0
72.0
15
71.0
13.4
11.6
11.4
10
68.7
8.4
6.6
5
5.7
70.0
69.0
68.0
67.0
66.0
0
65.0
2001
2002
2003
2004
Defaulted, transferred or unknown
2005
2006
Failed
2007
Died
2008
Success
2009
Children with TB,
WHO European Region, 2010
About 10 000 children with TB
one dot = one child
14
The global response:
Stop TB Strategy & Global Plan
To save lives, prevent suffering, protect the vulnerable, and promote human rights
European Response
Berlin Declaration
EU and WHO EURO action plans for TB and MDR-TB control
 EU and WHO EURO monitoring frameworks
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
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
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
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
Expected Achievement of MAP
•
225 000 MDR-TB patients
diagnosed
•
127 000 MDR-TB patients treated
successfully;
Expected achievements due to the implementation of
MAP, 2011-2015
75,436
•
250 000 MDR-TB cases averted;
71,478
Estimated MDRTB cases
emerging
•
13 000 XDR-TB cases averted;
•
120 000 lives saved; and
MDR-TB cases,
detected
•
7 billion US $ is saved by averting
further emergence of M/XDR-TB
MDR-TB patients
enrolled on
treatment
60,756
60,756
45567
28,887
17,913
10512
MDR-TB patients
succesifully
treated
2011
2012
2013
2014
2015
Monitoring of MDR-TB,
European Region
Estimated MDR burden, among all
TB cases, WHO European Region
81 000 cases
(73 000 – 90 000)
Estimated percentage of MDR-TB
- Among new TB
- Among previously treated
13% (12 – 15%)
42% (38 – 47%)
Coverage of
-culture confirmation
-DST testing
39.3% (152 827)
85.7% (131 007)
Notified percentage of MDR-TB
- Among new TB
- Among previously treated
13.7% (11 659)
48.7% (16 587)
Detection Rate of all MDR-TB
cases
36% (32–39%)
(29 059)
Target by 2015
•
36% MDR-TB detection rate
among all emerging
85%
•
96% MDR-TB treatment
enrolment
Close to 100%
•
56% treatment success
75%
Joint launch of the MDR Action Plan, 2011
High level MDG6 Forum
October 2011, Moscow
23
Regional Committee resolution on M/XDRTB 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
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
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.
Thank you very much for your
attention
With thanks to
• All 53 Member States
• Colleagues from WHO/Europe and WHO
headquarters
www.euro.who.int/tb
[email protected]
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.

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