World TB Day 2017 - presentation

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 TB
Small-scale
pilot
projects
Nationwide
integrated
programmes
TB notification rate/100 000 40 36
Drug-susceptible success rate (%) 72 76
MDR-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
3.5
2.7
0
2
4
6
8
10
2000 2005 2010 2015 2020
Rateper100000population
Estimated TB mortality rate Projection 2016-2020 Target 2020
–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

New TB cases are decreasing
29.2
24.6
0
10
20
30
40
50
1990 1995 2000 2005 2010 2015 2020
Notification rate (all countries)
Projected if current trends continues
Target
–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

3.6
0.54
0
1
2
3
4
5
6
7
8
9
10
2000 2005 2010 2015
Estimated TB/HIV mortality rate Estimated TB mortality rate
3.6% annual increase
–8.5% yearly
3
36
0
10
20
30
40
50
60
70
80
2000 2005 2010 2015
Estimated TB/HIV rate Estimated TB incidence rate
–4.3% yearly
6.2% annual increase
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
67
53 49
New TB/HIV MDR-TB
Treatment outcomes,
WHO European Region, 2015 data
76
41
51
New TB/HIV MDR-TB
Not evaluated
Lost to follow-up
Failed
Died
Success

No reason for complacency
323 000 people
IN WHO EUROPEAN
REGION
FELL ILL LAST YEAR
FROM TB
32 000
people
DIE FROM TB
Every 15minutes

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

Who are tuberculosis patients?
Of the estimated 323 000new TB patients in 2015 in WHO European Region:
25 000
are children
111 000
are females
190 000
are males
8%
34%
58%

1%
3%
11%
45%
29%
11%
0–4 years
5–14 years
15–24 years
25–44 years
46–64 years
over 64 years
TB cases by age groups, %, WHO European Region, 2015
Almost one in two TB patients is an adult

Dr Zsuzsanna Jakab
WHO 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%
5.5
6.1
7.8 8.0
9.071.3
77.9
85.9 88.9 88.0
0.0
2.0
4.0
6.0
8.0
10.0
0
20
40
60
80
100
2011 2012 2013 2014 2015
%%
HIV testing coverage and percentage of HIV positive
among TB patients, WHO European Region, 2011–2015
Percentage of HIV among TB HIV testing coverage

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
88%
61%
36% 41%
HIV testing
coverage
TB/HIV case
detection
ART coverage Treatment
succes
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

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
77%
7% 4% 5% 7%
41%
21%
28%
7%
3%
Success Died Failed Lost-to-follow up Not evaluated
HIV negative
HIV positive
Treatment outcomes of new TB and relapses by HIV status,
14

Europe’s TB burden is among the lowest in the world, but the
number of new MDR-TB cases is the highest
275
27
116
36
65
246
86
142
0
50
100
150
200
250
300
AFR
AMR
EMR
EUR-53
EUR-18HPC
SEAR
WPR
Global
per100000population
TBincidence, WHO regions, 2015
11.0
1.1
6.0
14.0
31.4
10.0
5.5
7.9
-
5
10
15
20
25
30
35
AFR
AMR
EMR
EUR-53
EUR-18HPC
SEAR
WPR
Global
per100000population
MDR-TBincidence, WHO regions, 2015

77
69 69
63
58 56 53
47 43
29
21
48
21
14
37
32
24 25
32
22
9
25
13
6
16
4
0
25
50
75
100
PercentageofMDR-TB
Percentage of MDR-TB among retreatments
Percentage of MDR-TB among new cases
MDR-TB in new TB cases occurs four times more
often in Europe than in the rest of the world

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

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
MDRTURBERCULOSIS
EVERY 6TH NEW TB PATIENT EVERY 2ND PREVIOUSLY TB PATIENT

For the first time, more MDR-TB patients were successfully
treated in 2015, but new cases continue to rise
14%
18%
48%
52%
2011 2015
MDR-TB in new cases
MDR-TB treatment success rate

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
12%
9%
13%
18%
23%
2011 2012 2013 2014 2015
Percentage of XDR-TB among detected MDR-TB cases,

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, 2016–2020

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 - presentation

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