PPT Raviglione "Stop TB in my lifetime -Giornata Mondiale della Tubercolosi"

Giornata Mondiale della Tubercolosi

Milano, 14 March 2013

Photo: Riccardo Venturi

Dr Mario C Raviglione Director Stop TB Department

Overview

ü  Burden of TB, TB/HIV, MDR-‐TB

ü  Strategy and targets

ü  Impact of intervenEons, and progress in control and care

Estimated number of cases

Estimated number of deaths

1.4 million* (1.3–1.6 million)

8.7 million (8.3–9.0 million)

630,000 (460,000-‐790,000) out of ~12 million prevalent TB cases

All forms of TB

MulFdrug-‐resistant TB

HIV-‐associated TB 1.1 million (13%) (1.0–1.2 million)

430,000 (400,000–460,000)

Source: WHO Global Tuberculosis Report 2012 * Including deaths aUributed to HIV/TB

The Global Burden of TB -‐2011

Unknown, but probably > 150,000

Incidence rates, 2011

Highest rates in Africa, linked to high rates of HIV infecEon ~80% of HIV+ TB cases in Africa

Per 100 000 populaEon

≥300 150–299 50–149

0–24 25–49

TB/HIV co-‐infecEon: 80% of burden in Africa

ü  80% of all TB/HIV cases are in Africa

ü  TB leading cause of death in PLHIV

ü  ¼ of PLHIV worldwide die due to TB.

ü  PLHIV infected with TB 20-‐40 Emes

more likely to develop acEve TB.

ü  Untreated, TB in PLHIV leads to death

in weeks

The boundaries and names shown and the designaFons used on this map do not imply the expression of any opinion whatsoever on the part of the World Health OrganizaFon concerning the legal status of any country, territory, city or area or of its authoriFes, or concerning the delimitaFon of its fronFers or boundaries. DoUed lines on maps represent approximate border

lines for which there may not yet be full agreement. © WHO 2012. All rights reserved

EsEmated number of MDR-‐TB Cases, 2011 >60% of all cases are in 5 countries

Russian FederaEon 44,000

(14% of global MDR burden)

India 66,000


China 61,000


Philippines 11,000


Pakistan 10,000


South Africa 8,100

Based on old survey data

Who carries the burden of tuberculosis?

TB linked to HIV infecEon, malnutriEon, alcohol, drug and tobacco use, diabetes

…mostly, the most vulnerable

Migrants, prisoners, minoriEes, refugees face risks, discriminaEon & barriers to care

500,000 women and 65,000 children die of TB each year; 10 million “TB” orphans

TB spreads in poor, crowded & poorly venElated seangs

Francesco I had tuberculosis!

…El Cardenal tiene una salud frágil, consecuencia de una tuberculosis que lo atacó cuando era un niño y le dejó secuelas: le falta la parte superior alveolar del pulmón derecho… Sin embargo, físicamente es fuerte. El mismo se esfuerza para no ser menos que los demás y practica natación…

Estimated number of

cases

Estimated number of

deaths

500,000 (470,000–510,000)

All forms of TB (Children <15 yr)

* excluding deaths among HIV+ people

All forms of TB (in women)

2.9 million (range, 2.6–3.2 million)

500,000 * (range, 400,000–600,000)

64,000* (range, 58,000–71,000)

The global burden of TB in 2011: women & children Estimated TB incidence rates, by country, 2010

TB cases per 100 000

0–2425–4950–99100–299>=300No estimate

The global response: Stop TB Strategy & Global Plan

To save lives, prevent suffering, protect the vulnerable, & promote human rights

1.   Pursue high-‐quality DOTS expansion

2.   Address TB-‐HIV, MDR-‐TB, and needs of the poor and vulnerable

3.   Contribute to health system strengthening

4.   Engage all care providers

5.   Empower people with TB and communiEes

6.   Enable and promote research

Global Progress on impact

ü  51 million paEents cured, 1995-‐2011

ü  20 million lives saved since 1995

ü  2015 MDG target on track: global TB incidence rate peaked in early 2000s

ü  BUT, TB incidence declining too slowly, 1.4 million people sFll dying, MDR-‐TB response slow, gaps in financing

EsEmated lives saved 2005-‐2010 through collaboraEve TB/HIV intervenEons

CumulaFve 2005-‐10= 910,000 (800,000 – 1,100,000)

What are the challenges in 2013 if we target beher care, control and ulEmately “eliminaEon"?

1.   Funding not secure at system and individual level: TB is a catastrophic expenditure for the poor

2.   TB/HIV major impact in Africa, especially in women and children

3.   Weak health policies, systems and services

4.   Links with maternal and children services not yet a rouEne

5.   Un-‐engaged non-‐state pracEEoners, NGOs, FBOs and communiEes

6.   MDR-‐TB care and cure inadequate, especially among PLHIV

7.   Social and economic determinants maintaining TB

8.   Research awakening needed for new diagnosEcs, drugs and vaccines

Challenge: TB as a cause of maternal and child morbidity and mortality

ü  TB causes 1-‐16% of all inferElity and 15-‐40% of tubal inferElity

ü  Facility based studies: 12-‐14% of all TB cases are in children

ü  TB prevenEon for child contacts not pracEced

ü  Studies from SS Africa and India showed: –  TB as a cause of all maternal mortality: 6-‐15% –  TB as a cause of indirect maternal mortality: 15-‐34%

References: Khan M et al, AIDS 2001; 15:1857–63. Ahmed Y et al, Int J Tuberc Lung Dis 1999; 3:675–80. Panchabhai TS et al,. J Postgrad Med 2009; 55:8–11. Menendez C et al. PLoS Med 2008; 5:e44.

AcEon for MCH services

CUAMM posiEon paper

…First mothers and children (with TB)…. CUAMM deciding to get engaged at all levels in the fight against TB, as there cannot be proper maternal and child care in Africa without addressing asserFvely TB and TB/HIV

Prepared in collabora:on with the top Italian experts in TB

Many thanks to all for

choosing to

Stop TB!

PPT Raviglione "Stop TB in my lifetime -Giornata Mondiale della Tubercolosi"

Documents

Transcript of PPT Raviglione "Stop TB in my lifetime -Giornata Mondiale della Tubercolosi"