Global TB Report 2009

8/14/2019 Global TB Report 2009

1/87


2/87

WHO RepORt 2009

Gb Tbecss CtEpidEmioloGy, STraTEGy, FinanCinG


3/87

Wod Hah Oazao 2009

a ghts eseve. pbcts the W Heth ogzt c be bte WHo pess, W Heth ogzt, 20 avee a, 1211

Geev 27, Swtze (te.: +41 22 791 3264; x: +41 22 791 4857; e-: [email protected]). reqests ess t ece tste

WHo bcts whethe se cec stbt sh be esse t WHo pess, t the bve ess (x: +41 22 791 4806;

e-: [email protected]).

The esgts ee the esett the te ths bct t the exess whtseve the t

the W Heth ogzt cceg the eg stts ct, tet, ct e ts thtes, cceg the ett ts

tes bes. dtte es s eeset xte be es whch thee t et be geeet.

The et secc ces cet ctes cts es t tht the e ese ecee b the W Heth

ogzt eeece t thes s te tht e t ete. Es sss excete, the es et cts e

stgshe b t ct ettes .

a esbe ects hve bee tke b the W Heth ogzt t ve the t cte ths bct. Hweve, the b-

she te s beg stbte wtht wt k, ethe exesse e. The essbt the teett se the te

es wth the ee. i evet sh the W Heth ogzt be be ges sg ts se.

Cve esg b T Htt, WHo St TB detet. o the estte 9.3 ew cses TB tht cce 2007, 1.4 (15%) wee ecte

wth HiV. The WHo ac reg ccte 79% these HiV-stve TB cses, we b the WHo Sth-Est as reg (11%). i the bsece

te tetet, the tt te HiV-stve TB cses s hgh. Hweve, ths te c be sgct ece ve-tte HiV testg s

e vbe t TB tets tevets sch s e tetv the e e vbe t thse wh e HiV-stve. The cve ges t cht shwg the etve ctbt ctes (be ts) WHo egs (gee ts) t the gb be HiV-stve TB.

desge b ghcs

pte Swtze

WHo lb Ctgg--pbct dt

Gb tbecss ct : eeg, stteg, cg : WHo et 2009.

1.Tbecss, p evet ct. 2.Tbecss, p eeg. 3.Cst ess.

4.Tetet tce. 5.nt heth gs gzt stt. 6.Fcg, Heth.

7.Sttstcs. i.W Heth ogzt.

iSBn 978 92 4 156380 2 (nlm cssct: WF 300)

WHo/HTm/TB/2009.411


4/87

GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 iii

Co

ackwegeets

abbevts

Ky oins 1

Inroducion 5

Char 1. eidmioogy 6

Gs, tgets cts TB ct 6

TB cece, evece tt 7

icece 7

pevece 12

mtt 12S gess tws mdG St TB ptesh ct tgets 14

ivg eseet gess tws the 2015 ct tgets: the WHo Gb Tsk Fce

TB ict meseet 16

meseet cece 16

meseet evece 19

meseet tt 20

Stts ct eseet HBCs t the e 2008 20

Cse tcts 22

Tt cse tcts 22

Cse tcts sggegte b sex 22

Cse etect tes 23

Cse etect te, sces (doTS -doTS ges) 23

Cse etect te, doTS ges 26

otces tetet doTS ges 27

new se-st ve cses 27

re-tetet cses 29

Cs tetet tces HiV-stve HiV-egtve TB tets 30

pgess tws echg tgets cse etect tetet sccess 30

S 32

Char 2. Sragy 34

dt ete t WHo 2008 35doTS exs ehceet 35

doTS cvege bes tets tete 35

ptc ctet 37

E cse etect thgh qt-sse bcteg 37

Stze tetet wth sevs, tet st 40

dg s geet sste 41

mtg evt 41

aess TB/HiV, mdr-TB, the ees vebe ts 43

Cbtve TB/HiV ctvtes 43

dgss tetet mdr-TB 49

p vebe ts 54

Ctbte t heth sste stegtheg bse heth ce 54

itegt heth ce 54


5/87

ivWHO RepORt 2009 GloBal TuBErCuloSiS ConTrol

aget wth be g cg ewks 55

H esce eveet 55

iect ct 55

pctc ach t lg Heth 56

Egge ce ves 57

pbcvte x ches 57

itet Sts Tbecss Ce 58Ewe ee wth TB, ctes thgh tesh 58

avcc, cct sc bzt 58

Ct tct TB ce 58

ptets Chte Tbecss Ce 58

Ebe te esech 58

S 59

Char 3. Financing 60

dt ete t WHo 2008 60

nTp bgets, vbe g g gs 60

Hgh-be ctes 60

a ctes 63

Tt csts TB ct 64

Hgh-be ctes 64

a ctes 67

Css wth the Gb p 69

Hgh-be ctes 69

a ctes 69

Bgets csts e tet 71

Exetes ce wth vbe g chges the be tets tete 72

Gb F cg 74

Hgh-be ctes 74a ctes 74

Fg gs the gb c css 75

S 77

Concusions 78

Ann 1. profs o high-burdn counris 79

Ann 2. Mhods

dt cect vect vevew 173

Eeg svece 174

ieett the St TB Stteg 180

Fcg 181

Ann 3. th So tB Sragy, cas rors, ramn oucoms and simas o tB burdn 187

Ext tes 188

S b WHo eg 191

ac 197

The aecs 217

Este metee 237

Ee 249

Sth-Est as 269

Weste pcc 281

Ann 4. Survys o ubrcuosis disas and avaiabiiy o dah rgisraion daa a WHO,

by counry and yar 301


6/87

GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 v

Ackowdm

Ths et ws ce b ce te 15 ee: rche Bqeez, l Bc, a Beebch, aeeke Bs,

Ke Cce, des Fz, Kthee F, phe Gz, Chst Gebeg, T Htt, meh Hsse, ae p-

tj, mk uek, Cthee Wtt abg Wght. ove ct ws ve b l Bc Kthee

F.

The t cect ws evee b meh Hsse Cthee Wtt, wth t vet the st.

meh Hsse gze e eett sects t geet (cg cect, g, v-

t, evew w- wth ctes), wth st T Htt. ae ptj is Gc ccte evew

w- the c t tht e esete Chte 3, aex 1 aex 3. rche Bqeez, aeeke

Bs, des Fz, Chst Gebeg, meh Hsse, abg Wght mtte Zg evewe t ctb-

te t et w- essges t ete t eeg eett the St TB Stteg, the

ests whch e Chtes 1 2 aexes 1 3. dt the Ee reg wee cecte v-te jt b WHo the Ee Cete dsese pevet Ct, gec the Ee u bse

Stckh, Swee.

ret wtg ws e b Kthee F, phe Gz mk uek. K Begst, l Bc, yg-

ae Ch, des Fz, G Gg, Chst Gebeg, meh Hsse, Kt lth, pee-yves nv, iksh

ozk, Fb Sc, l Veebt, K Wee, abg Wght mtte Zg ctbte text tc sects

Chte 2. a Beebch ae ptj ve t t ce evew Chtes 1 3, esectve. H-

eess Geth, p n, m rvge d We ve t t ce evew vs sects the

et. Ke Cce ete the ete et.

phe Gz, meh Hsse Cthee Wtt se svece eegc t ee the

ges tbes Chte 1. meh Hsse se t bt eett the St TB Stteg ee

the ges tbes Chte 2, wth st des Fz, Chst Gebeg T Htt. ae ptjse the c t ee the ges tbes Chte 3, wth st is Gc.

The ct es tht e aex 1 wee esge b aeeke Bs, phe Gz, ae Ge, meh

Hsse, ae ptj Cthee Wtt. The ct ws e b meh Hsse (eeg stteg)

ae ptj (cg), wth st T Htt ae Gx. it t tc sects the es ws

ve b rche Bqeez, is Gc, yg-ae Ch, Kthee F, G Gg, Heess Geth, mgzt

Gzesk, Wesek Jkbwk, de Kbg, Kt lth, iksh ozk, Sh ott, agc S, mk

uek, pete v me, l Veebt abg Wght. aeeke Bs cte the evew these es b

ctes.

Kthee F, phe Gz ae ptj ee aex 2 (eths). T Htt ee aex 3 (ke stts-

tcs egs v ctes), wth st meh Hsse. a Beebch ee ses exstg

e sves the evece tbecss (TB) sese the vbt tt t vt egstt

sstes, whch e esete aex 4.

i t t the ce et te the st ete bve, the et beete the t thes t the

W Heth ogzt (WHo) the Jt ute nts pge HiV/aidS (unaidS), tc t c-

ect evew. ag thse ste bew, we thk tc a Bss, ae d, Khsh a He, de

Kbg, re lez-ote, msk ot agc S the j ctbt t t cect evew.

WHO hadquarrs Gnva and UNAIDS. pe Be, Vct Bg, Ee Gws, Eest J, rbet

mt, F mzev as re.

WHO Arican Rgion. aee awe, r Cht, The Cet, ntkt dthe, Jseh ik, Je Kgg,

Bh Ket, de Kbg, mwewe mbshe, Vess mgwe, ishe ns, We nkh, agc S,

nee Skk Heette Web.

WHO Rgion o h Amricas. r aeg, ab Beett, mth e G, Jh Ehebeg, mee Fcs,

re lez-ote, r rgez-Cz y Sv.


7/87

viWHO RepORt 2009 GloBal TuBErCuloSiS ConTrol

WHO easrn Mdirranan Rgion. i a, Sh Bgh, a Bss, yk Eg, Sev Hsev,

Kek ib, rh Jebe, Wsq Kh, a m, Se K Shh, akh Set, iees S, Bsh Se

Khe St.

WHO euroan Rgion. pe e Cb, ae d, lcc dt, neet Eg, aj Ge, Sbste iz,

Bhtg Kev, S mtc, dv mece, r St, Gbg Tsgt, mt v e B, rsvch Vet,

Ee ysv rch Zesks.

WHO Souh-eas Asia Rgion. mhe akht, Ew Ce, ae de mck, peet dew, Khsh aHe, Hs Kge, pth p m, Fs meht, n n, Sv Sh, K S i, Sbt Thsetk, Fse

Wes S Wsvth.

WHO Wsrn pacifc Rgion. Ce Heg, G mezzbtt, lh nge, Kts osg, msk ot,

Jcqes Sebet, Be Ts, Jhh Tsg, pete V me, mche Vts, rje yv l yhg.

The se ths et s t ve cehesve -t-te ssesset the TB eec gess

ct the sese t gb, eg ct eves. Ths ss s bse t bt tcts TB cses

the tces tetet ( svece sstes) s we s t ete t the eett cg the St

TB Stteg. dt e se b t TB ct ge ges wh e wk svece, stteg

cg ctes. These ee e ste aex 3, we thk the the vbe ctbt

cbt.

The c sce c st WHos wk tg evtg TB ct s the ute Sttes

agec itet deveet, wtht whch t w be ssbe t ce ths et. dt cect -

ss e s ste b g the gveets ast, Beg, C, dek, F, Fce, Ge,

ie, it, J, lxebg, the nethes, nw, Swee, Swtze the ute Kg s we s b ct-

bts the Ee u, the Ee Css, the B & me Gtes Ft. We ckwege wth

gtte the st these geces.

F, we thk Se Hbbs he exceet wk the esg t ths et. Se hs wke wth the St TB

detet ths ject es, he ctbt s get ecte. as s, he fexbt ecec

gtee tht ths et s bshe 24 mch, W TB d.


8/87

GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 vii

Aao

aCSm vcc, cct sc

bzt

aFB c-st bc

aFr WHo ac reg

aFro WHo reg oce ac

aidS cqe ecec se

amr WHo reg the aecs

amro WHo reg oce the aecs

ari sk ect

arT tetv theBmu bsc geet t

BraC Bgesh r avceet Cttee

CpT c-txze evetve the

CTBC ct-bse TB ce

dHiS dstct Heth it Stwe

doT ect bseve tetet

doTS the bsc ckge tht es the

St TB Stteg

drS g esstce svece sve

dST g sscetbt testg

ECdC Ee Cete dsese pevet

Ct

Emr WHo Este metee reg

Emro WHo reg oce the Este

metee

EnrS Eectc nt rec Sste

EQa exte qt ssce

Eur WHo Ee reg

Euro WHo reg oce Ee

FdC xe-se cbt ( FdC t-TB g)

FidEliS F ivtve doTS Exs,ge b the u

Find Ft ivtve new dgstcs

GdF Gb TB dg Fct

GlC Gee lght Cttee

Gli Gb lbt ittve

Gb F The Gb F t ght aidS, Tbecss

m

Gb p Gb p t St TB, 20062015

Gni gss t ce

HBC hgh-be ct whch thee e 22

tht cct xte 80%

ew TB cses sg ech e

HiV h ecec vs

Hrd h esce eveet

iCd-10 itet Sttstc Cssct

dseses

iEC t, ect, cct

ipT sz evetve the

irr cece te t

iSTC itet Sts Tbecss Ce

Kap kwege, tttes ctce

mdG me deveet G

mdr tg esstce (esstce t, t est,sz c)

mdr-TB tg-esstt tbecss

nGo gveet gzt

nrl t eeece bt

nTp t tbecss ct ge

eqvet

oemrS oe mec recs Sste

pal pctc ach t lg Heth

ppm pbcpvte mx

ppp pbcpvte pteshs

rdBmS et tbse geet sste

SCC sht-cse chethe

SEar WHo Sth-Est as reg

SEaro WHo reg oce Sth-Est as

Srl st eeece bt

Srln st eeece bt etwk

TB tbecss

TBTEam TB Techc assstce mechs

unaidS Jt ute nts pge

HiV/aidS

uniTaid tet ct the chse gs t tet HiV/aidS, TB

uSaid ute Sttes agec itet

deveet

WHa W Heth asseb

WHo W Heth ogzt

WHo-CHoiCE CHosg itevets tht e Cst-

Eectve

Wpr WHo Weste pcc reg

Wpro WHo reg oce the Weste pcc

Xdr-TB TB cse b mdr sts tht e s

esstt t fqe , t est,e sec-e jectbe get (kc,

kc / cec)


9/87


10/87

GloBal TuBErCuloSiS ConTrolWHO RepORt 2009 1

Ky o

1. Ths et s the 13th et gb ct

tbecss (TB) bshe b the W Heth og-

zt (WHo) sees tht stte 1997. its

se s t ve cehesve -t-te

ssesset the TB eec gess ct-

g the sese t gb, eg ct eves, the ctext gb tgets set 2015. rests e

bse t ete t WHo v ts st-

TB t cect 2008 the t

tht wee cecte eve e 1996 t 2007. The

196 ctes tetes tht ete t 2008

cct 99.6% the ws estte be

TB cses 99.7% the ws t.

2. The tgets gb TB ct e () tht the

cece TB sh be g b 2015 (mdG T-

get 6.c), () tht TB evece eth tes sh

be hve b 2015 ce wth the eve 1990,() tht t est 70% cet se-stve cses

sh be etecte tete doTS ges

(v) tht t est 85% cet se-stve

cses sh be sccess tete. The test t

sggest () tht the cece te hs bee g

sce 2004, () tht evece eth tes w be

hve t est thee sx WHo egs b 2015 c-

e wth bsee 1990, bt tht these tgets

w t be cheve the w s whe, () tht

the cse etect te eche 63% 2007 (v)

tht the tetet sccess te eche 85% 2006.

o tve es ts essetes t 2009 e omS et tte

ttbecese s e e s e ste Web q c-esss:

ls ts ces e e e 2009 e omS sbe tbecss se ee

cst e e st web qe se c s bj:

www.who.//cao/oa_o/2009/ky_o/

3. Gb, thee wee estte 9.27 cet

cses TB 2007. Ths s cese 9.24

cses 2006, 8.3 cses 2000 6.6

cses 1990. mst the estte be cses

2007 wee as (55%) ac (31%), wth

s ts cses the Este meteereg (6%), the Ee reg (5%) the reg

the aecs (3%). The ve ctes tht k st

t th tes tt bes cses 2007 e

i (2.0 ), Ch (1.3 ), ies (0.53

), nge (0.46 ) Sth ac (0.46

). o the 9.27 cet TB cses 2007,

estte 1.37 (15%) wee HiV-stve; 79%

these HiV-stve cses wee the ac reg

11% wee the Sth-Est as reg.

4. athgh the tt be cet cses TB s

cesg bste tes s est tgwth, the be cses e ct s g. The

te ece s sw, t ess th 1% e e. Gb,

tes eke t 142 cses e 100 000 t

2004. i 2007, thee wee estte 139 cet

cses e 100 000 t. icece tes e -

g ve the sx WHo egs (the excet s the

Ee reg, whee tes e xte st-

be).

5. Thee wee estte 13.7 evet cses

TB 2007 (206 e 100 000 t), ecese

13.9 cses (210 e 100 000 t) 2006.


11/87

2WHO RepORt 2009 GloBal TuBErCuloSiS ConTrol

6. a estte 1.3 eths cce g HiV-

egtve cet cses TB (20 e 100 000 -

t) 2007. Thee wee t 456 000 eths

g cet TB cses wh wee HiV-stve; these

eths e csse s HiV eths the itet-

Sttstc Cssct dseses (iCd-10). The

456 000 eths g HiV-stve cet TB cses

eqte t 33% HiV-stve cet cses TB

23% the estte 2 HiV eths 2007.

7. pevece tt tes e g gb

sx WHo egs. The reg the aecs s

we s the Este metee Sth-Est as

egs e tck t cheve the St TB ptesh

tgets hvg evece eth tes b 2015,

ce wth bsee 1990. The Weste pcc

reg s tck t hve the evece te b 2015,

bt the tt tget be w sse. ne-

the the evece the tt tgets w be et

the ac Ee egs. The g betwee

evece tt tes 2007 the tgets

these tw egs ke t ke tht 1990 ev-

ece eth tes w be hve b 2015 the

w s whe.

8. The estte bes HiV-stve TB cses

eths 2007 e xte be the bes

bshe b WHo evs es. Ths es t e

tht the be HiV-stve TB cses the -

be TB eths g HiV-stve ee be

betwee 2006 2007. new t tht bece v-

be 2008, tc ve-tte HiV

testg the ac reg, wee se () t estte

the bes cses eths 2007 () t

evse evs esttes the bes cses

eths tht h cce ee es. The bes

HiV-stve TB cses eths e estte t hve

eke 2005, t 1.39 cses (15% c-

et cses) 480 000 eths.

9. The test esttes the bes HiV-stve TB

cses eths wee bse, s s, esttes

HiV evece the gee t bshe b

the Jt ute nts pge HiV/aidS,

unaidS. The ew t tht bece vbe 2008

wee ect eseets the t TB cses

tht e cecte wth HiV 64 ctes (

15 ctes 2007). These 64 ect eseets

sggest tht HiV-stve ee e bt 20 tes

e ke th HiV-egtve ee t eve TB

ctes wth geeze HiV eec (ce

wth evs estte sx), betwee 26 37

tes e ke t eve TB ctes whee HiV

evece s we (ce wth evs estte

30). These hghe esttes wee se t estte thebe HiV-stve TB cses ctes whch

ect eseets wee t vbe.

10. Thee wee estte 0.5 cses tg-

esstt TB (mdr-TB) 2007. Thee e 27 ctes

( whch 15 e the Ee reg) tht cct

85% sch cses. The ctes tht k st

t th tes tt bes mdr-TB cses e

i (131 000), Ch (112 000), the rss Fee-

t (43 000), Sth ac (16 000) Bgesh

(15 000). B the e 2008, 55 ctes tet-

es h ete t est e cse extesve g-

esstt TB (Xdr-TB).

11. The WHo Gb Tsk Fce TB ict meseet

hs ce ecets bt hw t ese

gess ecg tes TB cece, evece

tt (the thee j cts ct).

These ce sstetc ss t sb-

t tct t cbe wth ve s-

vece sstes t ese cece, sves the

evece TB sese 21 gb cs ctes

betwee 2008 2015, stegtheg vt

egstt sstes t ese TB tt g

the cses eth. ieett Tsk Fce

ecets s ecess t ve eseet

gess tws the gb tgets set 2015 s

we s t ese gess TB ct sbseqet

es.

12. The St TB Stteg s WHos ecee ch

t ecg the be TB e wth gb tgets.

The sx j cets the stteg e: se

hgh-qt doTS exs ehceet; ess

TB/HiV, mdr-TB, the ees vebe

ts; ctbte t heth sste stegtheg

bse heth ce; egge ce v-

es; ewe ee wth TB, ctes thgh

tesh; ebe te esech. The St

TB pteshs Gb p t St TB, 20062015 sets

t the sce t whch the tevets ce the

St TB Stteg ee t be eete t cheve the

2015 tgets.

13. i 2007, 5.5 TB cses wee te b doTS -

ges (99% tt cse tcts). Ths ce

2.6 se-stve cses. The cse etect te

ew se-stve cses e doTS (tht s, the e-

cetge estte cet cses tht wee te

tete doTS ges) ws 63%, s

cese 62% 2006 bt st 7% sht the t-

get 70% st set 2000 ( te eset t 2005)

b the W Heth asseb (WHa) 1991. The tget

ws et 74 ctes tw egs the reg

the aecs (73%) the Weste pcc reg

(77%). The Sth-Est as reg (69%) st et

the tget. The cse etect te ws 60% the Est-

e metee reg, 51% the Ee reg 47% the ac reg.


12/87


14. Gb, the te tetet sccess ew se-

stve cses tete doTS ges 2006

eche the tget 85% st set b the WHa 1991.

Thee egs the Este metee (86%), West-

e pcc (92%), Sth-Est as (87%) egs

et the tget, s 59 ctes. The tetet sc-

cess te ws 75% the ac reg the reg

the aecs, 70% the Ee reg.

15. i 20062007, the Weste pcc reg 36 c-

tes et bth the tget cse etect te t

est 70% the tget tetet sccess te

t est 85% ew se-stve cses. The Sth-

Est as reg s cse t chevg bth tgets.

Ke bece the st ct sb-Sh ac t

cheve bth tgets.

16. Thee hs bee j gess eetg teve-

ts sch s testg TB tets HiV vg

c-txze evetve the (CpT) tetv- the (arT) t HiV-stve TB tets. Gb,

1 TB tets (16% te cses) kew the

HiV stts 2007. The getest gess HiV testg

ws the ac reg, whee 0.5 TB tets

(37% te cses) kew the HiV stts

2007. o the 250 000 HiV-stve TB tets, 0.2 -

wee ee CpT 0.1 wee stte

arT. i bth cses, ges wee hghe th thse

ete t WHo evs es.

17. deste the gess tht hs bee e wth scg

cbtve TB/HiV ctvtes, gess HiV testgs tcg gess the vs CpT arT.

The be HiV-stve TB tets beg tete

wth CpT arT s s ce wth the 0.3 -

TB tets kw t be HiV-stve, se

st ce wth the estte 1.4 HiV-s-

tve TB cses ( wh e t etecte doTS

ges, gve cse etect te 47%). Cse

etect doTS ges s we s cbtve

TB/HiV ctvtes ee t be exe t ese tht

() e ee kw the HiV stts () tht

thse wh e HiV-stve, wth wtht TB, hve

ccess t te te tetet ce.

18. Gb, jst e 30 000 cses mdr-TB wee t-

e t WHo 2007, st b Ee ctes

Sth ac. Ths ws 8.5% the estte gb

tt se-stve cses mdr-TB. o the te

cses, 3681 wee stte tetet jects -

ges ve b the Gee lght Cttee (GlC),

e ths kw t be ecevg tetet cc-

g t tet gees. Ths s eqvet t 1%

the estte gb tt se-stve cses

mdr-TB. The be tets stte tetet

GlC-ve jects ges s execte

t cese t 14 000 2009, eqvet t

4% the se-stve cses mdr-TB estte t

exst gb. T eet the tgets set the Gb p,

gss tetet mdr-TB ee t be

sce , esec the thee ctes tht cct

57% gb cses: Ch, i the rss

Feet.

19. dgstc tetet sevces TB e tegte

t heth ce st ctes.20. nt s TB ct e ge wth t-

heth stteges e th h the 22 hgh-

be ctes (HBCs). mst nTps e s vvg

the stes, sscts sttts the

eveet the s. Wth eewe ehss

heth sste stegtheg, thee s stg bss

cse cbt ke cheges sch s sst-

be cg, h esce eveet, ect

ct heth t sstes.

21. The ctbt bcvte x (ppm) ttves

t etect tetet TB cses s ct tqt st ctes, bt exes sch s pk-

st the phes (whee bcvte te-

shs ccte 19% 8% tcts

2007, esectve) stte the tet t ctb-

te t cese cse etect. The ctbt c-

tes t gss tetet TB s s h t

qt. m ctes eqe gce st

t esg, eet evte vcc, c-

ct sc bzt ctvtes (aCSm).

22. a tt uS$ 3.0 b s vbe TB ct

2009 94 ctes tht ete t, whchcct 93% the ws TB cses: ths tt,

87% s g gveets (cg s), 9%

s g Gb F gts 4% s g

s the th the Gb F. mst the

vbe g s the Ee reg (uS$ 1.4 b -

, st the rss Feet), we b the

ac reg (uS$ 0.6 b) the Weste pcc

reg (uS$ 0.3 b). The g gs ete b

these 94 ctes t t uS$ 1.2 b 2009.

23. The tt uS$ 4.2 b eqe ee-

tt ct s these 94 ctes 2009s st doTS (uS$ 3 b, 72%). The the

j cets e mdr-TB (uS$ 0.5 b, 12%;

76% the tt mdr-TB s ccte b the

rss Feet Sth ac), cbtve

TB/HiV ctvtes (uS$ 120 , 3%) aCSm

(uS$ 100 , 2%). The eg 11% ces

ppm, sves the evece TB sese, c-

t-bse TB ce vet scees ctv-

tes.

24. i the 22 HBCs whee 80% the ws TB cses cc,

tt uS$ 2.2 b s vbe 2009, scese uS$ 27 ce wth 2008 bt sb-

stt bve the uS$ 1.2 b tht ws set


13/87


TB ct 2002 (whe WHo beg c t-

g TB ct). mst the cese g sce

2002 hs ce estc g Bz, Ch

the rss Feet, exte cg

the Gb F. The HBCs ete cbe g

g uS$ 0.50.7 b 2009 (the ge efects

cett bt the eve g vc

gveets Sth ac) .

25. The tt uS$ 2.9 b eqe eet-

t ct s the 22 HBCs 2009 s st

doTS (uS$ 2 b, 69%). The the j c-

ets e mdr-TB (uS$ 0.4 b, 14%; 88%

ths tt s ccte b the rss Feet

Sth ac), TB/HiV (uS$ 90 , 3%)

aCSm (uS$ 70 , 2%). The eg 12%

ces ppm, sves the evece TB sese,

ct TB ce vet scees ctv-

tes.

26. o the uS$ 2.2 b vbe the 22 HBCs 2009,

88% s HBC gveets, 8% (uS$ 169 )

s the Gb F 4% (uS$ 94 ) s

gts sces the th the Gb F.

The stbt g sces s eet whe the

rss Feet Sth ac e exce: the

gveet ctbt t vbe g s t

70%, the Gb F ctbt ceses t 19%

gts sces beses the Gb F cct

11%.

27. The g betwee the vbe g ete b

the 22 HBCs 2009 the g eqeets

these ctes ccg t the Gb p 2009 s

uS$ 0.8 b. The g betwee the vbe g

ete b the 94 ctes wth 93% gb cses

2009 the g eqe these ctes

2009 ccg t the Gb p s uS$ 1.6 b.

mst the ext g eqe ccg t the

Gb p s mdr-TB gss tetet

the Sth-Est as Weste pcc egs (st

i Ch), doTS cbtve TB/

HiV ctvtes ac.

28. The gb be TB s g sw, t est

thee sx WHo egs e tck t cheve gb

tgets ecg the be cses eths

tht hve bee set 2015. Hweve, whe cesg

bes TB cses hve ccess t hgh-qt t-

TB tetet s we s t ete tevets sch

s arT, estte 37% cet TB cses e t

beg tete doTS ges, t 96% c-

et cses wth mdr-TB e t beg gse

tete ccg t tet gees, the j-

t HiV-stve TB cses t kw the HiV st-

ts the jt HiV-stve TB tets wh

kw the HiV stts t hve ccess t arT. T

cceete gess gb TB ct, these bes

ee t be ece sg the ge tevets

ches ce the St TB Stteg.


14/87


Ths et s the 13th et gb ct

tbecss (TB) bshe b the W Heth ogz-

t (WHo) sees tht stte 1997. its se

s t ve cehesve -t -te ssesset

the TB eec t et gess ctg the

sese t gb, eg ct eves, the ctext

gb tgets set 2015. The c tgets e tht

the cece TB sh be g b 2015 (mdG Tget

6.c), tht TB evece eth tes sh be hve b

2015 ce wth the eve 1990, tht t est 70%

cet se-stve cses sh be etecte tete doTS ges, tht t est 85% ew s-

t se-stve cses sh be sccess tete.1,2,3,4

rests e bse t ete t WHo v ts

st TB t cect 2008 the t

tht wee cecte ech e 19962007. The 196 ctes

tetes tht ete t 2008 cct 99.6%

the ws estte TB cses 99.7% the ws

t.

The et s stcte thee j chtes.

CHApter 1 cses eeg. it ces WHos

test esttes the eegc be TB (c-ece, evece tt) , cse tcts ete

2007, esttes the cse etect te ew se-

stve cses s we s tes cse betwee 1995

(whe ebe tg beg) 2007, tetet

tces betwee 1994 2006 ew e-tetet

cses. ptc ttet s gve t tw tcs. The st s

te esttes the bes TB cses eths

g HiV-stve ee, whch hve bee evse sb-

stt ws sg ew t tht bece vbe

2008. The sec s ecet ecets bt hw

t ve eseet the eegc be

TB tg gess tws ct tgets (.e.

ects cece, evece tt) 2009

ws, whch hve bee e b WHos Gb Tsk Fce

TB ict meseet.

CHApter 2 ses gess eetg WHos

St TB Stteg, whch s esge t cheve the gb

tgets set 2015.5 The stteg ws che 2006

s bt the ts the doTS stteg, the

tet-ecee ch t TB ct v-

cte b WHo the -1990s t 2005. The sx j

cets the stteg (doTS eett; ess-

g TB/HiV, mdr-TB the ees vebets; ctbtg t heth-sste stegtheg

bse heth ce; eggg ce ves;

eweg ee wth TB, ctes; -

tg esech) e esse t. Wheeve ssbe,

css e e wth the tgets scg te-

vets tht wee set the St TB pteshs Gb

p t St TB. Exes hw eet cets

the stteg c be eete bse ecet ct

exeece whch hve we cbt e s hgh-

ghte. These ce scg bcvte cbt

pkst, tetet tg-esstt TB (mdr-TB)

Est ltv, tcg eectc ecg

etg m, vs tetv tet-

et (arT) ac.CHApter 3 ses cg TB ct. The t

esete ce the bgets t TB ct -

ges (nTps), vbe g g gs

these bgets, betwee 2002 (whe ebe tg

beg) 2009; esttes the tt csts TB ct,

whch ce nTp bgets s the csts sscte wth

se gee heth-sste st stcte tht e

s t ce nTp bgets; css g

ees set t the Gb p wth ctes ssessets

the g ees; e tet csts bgets;

exetes ce wth vbe g chges the be tets tete. pgess wth g

bgetg TB ct the ssbe cseqeces

the gb c css tht evee 2008 e s

hghghte.

The t the et es wth s the

j ccss thee chtes (COnClusiOns).

The ee the et cssts exes. These

ce ct es the 22 hgh-be ctes

(Annex 1), ext eths (Annex 2), ct-

secc t 19902007 (Annex 3), s

the ctes whee sves the evece TB sese

hve bee ccte e e the ctes

whch tt t vt egstt sstes e v-

be cet WHo tbse (Annex 4).

1 The me deveet Gs e escbe t stts..g/s

2 rest WHa44.8. Tbecss ct ge. i: Handbook oresolutions and decisions o the World Health Assembly and the ExecutiveBoard. Ve iii, 3 e. (19851992). Geev, W Heth ogz-t, 1993 (WHa44/1991/rEC/1).

3 Stop Tuberculosis Initiative. Report by the Director-General. Ft-thW Heth asseb. Geev, 1520 m 2000 (a53/5, 5 m2000).

4 de C et . Tgets gb tbecss ct. International Journal

o Tuberculosis and Lung Disease, 2006, 10:460462.5 rvge mC, uek mW. WHos ew St TB Stteg. Lancet, 2006,

367:952955.6 The Global Plan to Stop TB, 20062015. St TB ptesh WHo.

Geev, W Heth ogzt, 2006 (WHo/HTm/STB/2006.35).

iodco


15/87


L CHapTEr 1

edmooy

WHo hs ssesse the stts the TB eec gess

ct the sese eve e sce 1997. Ths ssess-

et hs ce esttes TB cece, evece

tt ( 1990 ws); ss cse tcts

( 1995) tetet tces ( 1994)

200 ( 212) ctes tetes, wg the stt

ebe ecg etg 1995; ss

gess tws the gb tgets cse etect

tetet sccess estbshe b the W Heth asseb

(WHa) 1991. Sce 2006, WHo hs s ssesse gess

tws chevg the ct tgets ete t cece,evece tt tht hve bee set 2015 wth

the ewk the me deveet Gs (mdGs)

b the St TB ptesh.

Ths chte ves WHos test ssesset the stts

the TB eec gess tws chevg the gb

tgets sg t ete b 196 ctes tetes

(cctg 99.6% the ws estte be TB

cses 99.7% the ws t) 2008 s we

s t ete evs es. it s stcte seve

j sects. The st ees the gb tgets c-

ts TB ct set 2005, 2015 2050. The secsect esets the test esttes TB cece, ev-

ece tt, cg esttes 2007 the

e sce 1990, scsses whethe the w s whe

secc egs e tck t ech the 2015 mdG

St TB ptesh tgets. The esttes TB cece

tt ce tt tes t evs bshe

esttes the bes HiV-stve TB cses eths.

Bg the sec sect, the th sect ves

vevew ecet ecets the WHo Gb

Tsk Fce TB ict meseet bt hw t ese

gess tws the 2015 ct tgets. These ece-

ts cs stegtheg svece ( cses

eths) ctes eetg sves the

evece TB sese 21 gb cs ctes. recet

exes hw the ecets c be e c-

tce e ve. The th sect esets TB tct

t 2007, cg e we sete. The

th sect ces the test esttes the cse etect

te, the sxth sect ets tetet tces 2006,

the seveth sect ssesses eg ct g-

ess tws chevg the tgets bth cse etect

tetet sccess. The chte es wth s the

ests ccss.The eths se t ce the ests esete ths

chte e exe Annex 2. Thght ths chte,

tc ttet s gve t the 22 hgh-be ctes

(HBCs) tht cectve cct 80% cet TB cses

gb. at t e ve HBCs Annex 1

ctes Annex 3.

1.1 Goas, args and indicaorsor tB conro

The gb tgets cts TB ct wee eve-

e wth the ewk the mdGs s we s b the

St TB ptesh the WHa (tAble 1.1).1,2 The ct

tgets e t ht beg t evese the cece TB b

2015 t ece b 50% evece tt tesb 2015 etve t 1990 eves. The cece tget s t

mdG Tget 6.c, whe the tgets ecg evece

eth tes wee bse est the e 2000

eetg the G Eght (G8) stze ctes,

he okw, J. The tce tgets t cheve

cse etect te ew se-stve cses t est

70% t ech tetet sccess te t est 85%

sch cses wee st estbshe b the WHa 1991.

Wth the mdG ewk, these cts wee ee s

the t cses etecte ce e doTS. The

tte g etg TB, ee s the ccece ess th 1 cse e t e e b 2050, ws

set b the St TB ptesh.

The St TB Stteg,3 che b WHo 2006, sets

t the j tevets tht sh be eete t

cheve the mdG, St TB ptesh WHa tgets.

These e ve t sx b cets: () sg

hgh-qt doTS exs ehceet; () ess-

g TB/HiV, mdr-TB the ees vebe

ts; () ctbtg t heth-sste stegtheg

bse heth ce; (v) eggg ce ves;

(v) eweg ee wth TB, ctes thgh

tesh; (v) ebg tg esech. The

Gb p t St TB, che b the St TB ptesh

2006, sets t hw, t wht sce, the St TB Stteg

sh be eete ve the ece 20062015, the

g eqeets.2 Ths es tht t t the t-

gets shw tAble 1.1, the Gb p s ces t

tgets (g eqe e e) tt tgets (

exe, the be tets wth mdr-TB wh sh be

1 de C et . Tgets gb tbecss ct. International Journalo Tuberculosis and Lung Disease, 2006, 10:460462.

2 The Global Plan to Stop TB, 20062015: actions or lie towards a world

ree o tuberculosis. Geev, W Heth ogzt, 2006 (WHo/HTm/STB/2006.35).

3 The Stop TB Strategy: building on and enhancing DOTS to meet the TB-related Millennium Development Goals. Geev, W Heth ogz-t, 2006 (WHo/HTm/TB/2006.368).


16/87


tete ech e, be TB tets t be teste HiV,

be HiV-stve TB tets wh sh be ee

tetv the (arT)) .

Ths chte cses the ve c cts tht

e se t ese the ct tces TB ct:

cece, evece eths (ct cts),

cse etect tetet sccess tes (tce c-

ts). a ss gess tws chevg the tgets

s ve CHApter 2 CHApter 3.

1.2 tB incidnc, rvanc and moraiy

1.2.1 icdc

Bse svece sve t ( Annexes 2, 3

4), WHo esttes tht 9.27 ew cses TB

cce 2007 (139 e 100 000 t), ce

wth 9.24 ew cses (140 e 100 000 t)

2006. o these 9.27 ew cses, estte 44%

4.1 (61 e 100 000 t) wee ew se-

stve cses ( tAble 1.2; Figure 1.1). i, Ch, i-

L tABle 1.1goa, a ad dcao o tb coo

HeAltH in tHe MillenniuM DevelOpMent gOAls

goa 6: Coma Hiv/AiDs, maaa ad oh da

Tget 6c: Ht beg t evese the cece the j seses

ict 6.9: icece, evece eth tes sscte

wth TBict 6.10: pt TB cses etecte ce edoTS

so tb pah a

B 2005: at est 70% ee wth st se-stve TB w be gse (.e. e the doTSstteg), t est 85% sccess tete.The tgets cse etect te t est70% tetet sccess te t est85% wee st set b the W Heth asseb WHo 1991.

B 2015: The gb be TB (e ct evece eth tes) w be ece b 50% etvet 1990 eves.

B 2050: The gb cece ctve TB w be ess th1 cse e t e e.

L tABle 1.2emad dmooca d o tb, 2007

inCidEnCE prEValEnCE morTaliTy

all FormS SmEar-poSiTiVE all FormS HiV-nEGaTiVE HiV-poSiTiVEHiV prEV.

pEr pEr pEr pEr pEr in inCidEnT

populaTion numBEr 100 000 pop numBEr 100 000 pop numBEr 100 000 pop numBEr 100 000 pop numBEr 100 000 pop TB CaSESb

1000s 1000s pEr yEar 1000s pEr yEar 1000s pEr yEar 1000s pEr yEar 1000s pEr yEar %

1 i 1 169 016 1 962 168 873 75 3 305 283 302 26 30 2.5 5.3

2 Ch 1 328 630 1 306 98 585 44 2 582 194 194 15 6.8 0.5 1.9

3 ies 231 627 528 228 236 102 566 244 86 37 5.4 2.4 3.0

4 nge 148 093 460 311 195 131 772 521 79 53 59 40 27

5 Sth a c 48 577 461 948 174 358 336 692 18 38 94 193 73

6 Bgesh 158 665 353 223 159 100 614 387 70 44 0.4 0.3 0.3

7 Eth 83 099 314 378 135 163 481 579 53 64 23 28 19

8 pkst 163 902 297 181 133 81 365 223 46 28 1.4 0.9 2.1

9 phes 87 960 255 290 115 130 440 500 36 41 0.3 0.3 0.3

10 dr Cg 62 636 245 392 109 174 417 666 45 72 6.0 10 5.9

11 rss Feet 142 499 157 110 68 48 164 115 20 14 5.1 3.6 16

12 Vet n 87 375 150 171 66 76 192 220 18 20 3.1 3.5 8.1

13 Ke 37 538 132 353 53 142 120 319 10 26 15 39 48

14 Bz 191 791 92 48 49 26 114 60 5.9 3.1 2.5 1.3 14

15 ur Tz 40 454 120 297 49 120 136 337 12 29 20 49 47

16 ug 30 884 102 330 42 136 132 426 13 41 16 52 39

17 Zbbwe 13 349 104 782 40 298 95 714 6.9 52 28 213 6918 Th 63 884 91 142 39 62 123 192 10 15 3.9 6.0 17

19 mzbqe 21 397 92 431 37 174 108 504 10 45 17 82 47

20 m 48 798 83 171 37 75 79 162 5.4 11 0.9 1.9 11

21 Cb 14 444 72 495 32 219 96 664 11 77 1.8 13 7.8

22 aghst 27 145 46 168 21 76 65 238 8.2 30 0.0 0 0

Hh-d co 4 201 761 7 423 177 3 245 77 11 301 269 1 058 25 339 8.1 14

aFr 792 378 2 879 363 1 188 150 3 766 475 357 45 378 48 38

amr 909 820 295 32 157 17 348 38 33 3.6 7.9 0.9 11

Emr 555 064 583 105 259 47 772 139 97 17 7.7 1.4 3.5

Eur 889 278 432 49 190 21 456 51 56 6.3 8.1 0.9 9.8

SEar 1 745 394 3 165 181 1 410 81 4 881 280 497 28 40 2.3 4.6

Wpr 1 776 440 1 919 108 859 48 3 500 197 276 16 15 0.8 2.7goa 6 668 374 9 273 139 4 062 61 13 723 206 1 316 20 456 6.8 15

icece evece esttes ce TB ee wth HiV.b pevece HiV cet TB cses ges.


17/87


L FIGURe 1.1emad m o w tb ca, y coy, 2007

0999

10009999

10 00099 999

100 000999 999

1 000 000

No estimate

Estimated number ofnew TB cases (all forms)

L FIGURe 1.2emad tb cdc a, y coy, 2007

024

2549

5099

100299

300

No estimate

Estimated new TBcases (all forms) per100 000 population


18/87


es, nge Sth ac k st t th tes

the tt be cet cses; the estte bes

cses these the HBCs 2007 e s shw

tAble 1.2. as (the Sth-Est as Weste pcc

egs) ccts 55% gb cses the ac

reg 31%; the the thee egs (the aecs, E-

e Este metee egs) cct s

cts gb cses. The gte the TB be

wth ctes c s be exesse s the be c-

et cses e 100 000 t (Figure 1.2). ag

the 15 ctes wth the hghest estte TB cece

tes, 13 e ac, hee ke t hgh tes

HiV cect (Figure 1.3; Figure 1.4).

Incidence o TB among people inected with HIV

ag the 9.27 cet cses TB 2007, est-

te 1.37 (14.8%) wee HiV-stve (tAble 1.2).

Ths be, thgh be the estte 0.7

cses 2006 tht WHo bshe 2008,1 es t e

tht the be HiV-stve cses TB be betwee

2006 2007; the, ew t tht bece vbe -

g 2008 hve bee se t estte bth the be

HiV-stve TB cses 2007 t evse esttes the

be sch cses tht cce evs es. The

gb be cet HiV-stve TB cses s estte

t hve eke 2005, t 1.39 . i 2007, s e-

vs es, the ac reg ccte st (79%)

L FIGURe 1.3emad Hiv ac w tb ca, 2007

04

519

2049

50

No estimate

HIV prevalence in newTB cases, all ages (%)

0 200 400 600 800 1000 1200

Congo

Gabon

Cte dIvoire

Togo

Mozambique

Cambodia

Zambia

Sierra Leone

Lesotho

Botswana

Namibia

Zimbabwe

Djibouti

South Africa

Swaziland

Incidence (per 100 000 population per year)

L FIGURe 1.4F co wh h hh mad tb cdc a caa (a om; y a) ad cood cdca o Hiv-o tb ca (d a), 2007

1 Global tuberculosis control: surveillance, planning, fnancing. WHOreport 2008. Geev, W Heth ogzt, 2008 (WHo/HTm/TB/2008.393).


19/87


HiV-stve TB cses, we b the Sth-Est

as reg ( i) wth 11% tt cses

(Figure 1.5). Sth ac ccte 31%

cses the ac reg.

as ee ets ths sees, the ew

esttes wee ce sg the test gb

esttes HiV evece g the gee

t ( ges) bshe b the Jt utents pge HiV/aidS (unaidS) .1 Thee

e tw ew ete chges t the t

eths se ths et. Fst , ect ese-

ets the evece HiV TB tets

wee vbe ch ge be

ctes ( ve-tte HiV testg

49 ctes sves sete svece

15 ctes). Sec, these ect ese-

ets sggest tht the sk eveg TB

HiV-stve ee ce wth HiV-egtve

ee (the cece te t, irr) s hgh-

e th evs estte ( exe, 20.6ce wth the evs estte 6 c-

tes wth hgh evece HiV the gee

t). new hghe esttes the irr

wee se t ce ect esttes the

be HiV-stve TB cses 104 ctes

whch ect eseets the evece

HiV TB tets wee t vbe.2 The ew

esttes sscte t eths e

sze bOx 1.1 exe eet Annex 2. Esttes ctes e

ce Annex 3.

Estimated incidence o MDR-TB

Esttes the be tg esstt TB

(mdr-TB) e esete b ct, sggegte

b se stts, Annex 3. mst the cet

t bt the t TB cses wth

mdr-TB ces g sscetbt testg

(dST) ses tets wh mdr-TB

s gse bc heth ctes e c-

ts ee b the WHo/iuaTld Gb pject

dg resstce Svece (drS).3 These c-

ts ce cete stsct ece

btes bse exte qt ssce(EQa) eqte ec eve tets

tetet hst. Sch t e vbe ew

e-tetet cses 113 102 ctes,

esectve. usg set we esbe, e-

eet vbes tht e ectve the eqe-

c mdr-TB (sch s gss t ce (Gni)

BOx 1.1

Rvising simas o h numbrs o tB cass and dahsamong HIV-osiiv o

Ths et ces esttes the bes HiV-stve TB cses eths

tht e sbstt hghe th thse bshe evs es. it s estt-

e tht, 2007, thee wee 1.37 cet cses HiV-stve TB (14.8%

tt cet cses) 456 000 eths TB g HiV-stve ee

(eqvet t 26% eths TB HiV-stve HiV-egtve ee, 23% estte 2 HiV-ete eths).1

These estte bes TB cses eths g HiV-stve ee

2007 e xte be thse bshe evs ets. Ths es t

e tht the bes HiV-stve TB cses TB eths g HiV-s-

tve ee be betwee 2006 2007. iste, ew t tht bece

vbe g 2008 hve bee se t estte bth () the bes HiV-

stve TB cses eths 2007 () t evse evs esttes the

bes cses eths tht cce ee es. The evse esttes

sggest tht the be HiV-stve TB cses eths eke 2005 t

1.39 cet cses (15.1% tt cet cses) 480 000 eths.

as evs ets ths sees, the esttes e bse the test gb

esttes HiV evece g the gee t ( ges) bshe

b the Jt ute nts pge HiV/aidS (unaidS).1 Wht s ew

ths et s tht ect eseets the evece HiV TB tets

wee vbe ch ge be ctes. These ect ese-

ets wee st ve-tte HiV testg TB tets (49 c-

tes, 13 ctes the evs e). pve-tte HiV testg

hs bee exe sce 20052006, tb ac ctes (see

s CHApter 2). F the 15 ctes, ect eseets wee vbe

sves sete svece ( tw ctes the evs e).

These 64 ect eseets wee se t estte the be cet HiV-

stve TB cses 64 ctes tht cct 32% the estte tt

1.37 HiV-stve TB cses.

These ect eseets ve stg evece tht the etve sk

eveg TB HiV-stve ee s ce wth HiV-egtve ee (the

cece te t, irr) s hghe th evs estte. The irr ws

estte s 20.6 (95% cece tev (Ci) 15.427.5) 2007 ctes

wth geeze HiV eec (.e. ctes whee the evece HiV s

bve 1% the gee t), s 26.7 (95% Ci 20.434.9) ctes

whee the evece HiV the gee t s betwee 0.1%

1%, 36.7 (95% Ci 11.6116) ctes whee the evece HiV

the gee t s ess th 0.1%. These irr esttes ce wth e-

vs esttes 6, 6 30, esectve.2 Hghe esttes e csstet

wth ects the esttes HiV evece the gee t

bshe 2007 b unaidS (whch b et e t cese ev-

s irr esttes gve eve HiV evece g TB tets)

wth evece tht the irr ceses s the HiV eec tes. The we

cece tevs these irrs stte tht ge cett es,

thgh the getest cett s ctes wth w HiV evece ththve s ct gb esttes. The ew irr ges wee se t

ce ect esttes the be HiV-stve TB cses 104 c-

tes whch ect eseets the evece HiV TB tets wee

t vbe.

T cese the ebt these esttes, the cvege HiV svece

g TB tets ees t be ve. Fthee, ect eths w

bece e betc s the cvege ct tetv the-

(arT) ceses. me t e eee, tc t HiV -

ges, t bette est the ct arT the cece TB.

1 htt://www.s.g/e/KwegeCete/HiVdt/Eeg/testEdt.s

2 These ee esttes the irr wee bse thgh evew the evececcte 20002001. See Cbett El et . The gwg be tbecss:gb tes tects wth the HiV eec. Archives o Internal Medicine,2003, 163:10091021.

1 htt://www.s.g/e/KwegeCete/HiVdt/Eeg/testEdt.s

2 unaidS es t ce esttes HiV evece thegee t the eg 44 ctes tet -es. F ths es, esttes the be HiV-stve

TB cses these ctes tetes wee t ce.3 Anti-tuberculosis drug resistance in the world, 4th report:

the WHO/IUATLD Global Project on Anti-tuberculosis DrugResistance Surveillance. Geev, W Heth ogzt,2008 (WHo/HTm/TB/2008.394).


20/87


e ct, the t e-tetet t ew tets, the

e te sscte wth st-e tetets), t s ssbe

t estte the eqec mdr-TB ctes whee t

hs t bee ese ect. The gee eths se

t ce these esttes e esete Annex 2, whe

Annex 3 ees whethe the ect ect eth ws

se ech ct.

i 2007, thee wee estte 9.27 st e-

ses TB t 1.16 sbseqet e-

ses TB (eses ccg tets wh h e

exeece t est e evs ese TB the st

wh h eceve t est e th t-TB tet-

et). ag these, 10.4 eses TB (st

sbseqet), estte 4.9% 511 000 wee cses

mdr-TB. o these, 289 000 wee g ew cses (3.1%

ew cses) 221 000 wee g cses tht hbee evs tete TB (19% evs tete

cses). o the 511 000 cet cses mdr-TB 2007,

349 000 (68%) wee se-stve. The ctes wth the

gest be cses mdr-TB, ke ecesg

e, e shw Figure 1.6.

Trends in incidence since 1990 and progresstowards MDG Target 6.c

F sees tct t sves (Annexes 2, 3

4), the gb cece TB e ct es t hve

eke 2004 s w ece (Figure 1.7; Figure1.8). Ths ek sbseqet ece w s t-

te t the te HiV evece the gee t

(Figure 1.7). The es wh the be cet cses

L FIGURe 1.5goahca do o mad m oHiv-o tb ca, 2007. F ech ct (e cces) WHo eg (ge cces), the be cet TB csessg ee wth HiV s shw s ecetge thegb tt sch cses.

DR Congo

Cte dIvoire

Mozambique

Zambia

Zimbabwe

South Africa

Russian Federation

1 2 5 10 20 50 90

Percentage of global estimated HIV-positive TB cases

AFR

SEAR

Nigeria

India

Kenya

Ethiopia

UR Tanzania

WPR

EUR

Uganda

AMR

Malawi

China

EMR

Indonesia

Thailand

Cameroon

Rwanda

L FIGURe 1.6Co wh h hh m o mad MDr-tbca, 2007. Hzt es ete 95% cece tevs.The sce esttes s g esstce svece sves(drS, e) eg ( ge).

DR Congo

Cte dIvoire

Mozambique

Zimbabwe

South Africa

Russian Federation

Nigeria

India

Kenya

Ethiopia

UR Tanzania

China

Indonesia

Thailand

Republic of Moldova

2000 10 000 50 000 100 000

Number of cases

BangladeshPakistan

Philippines

Kazakhstan

Ukraine

Uzbekistan

DPR Korea

Viet Nam

Tajikistan

Myanmar

Azerbaijan

Peru

Republic of Korea

Sudan

AfghanistanDRS

Model

L FIGURe 1.7emad cdc o tb ad ac o Hiv o hAca o mo acd y Hiv (Aca hh-Hiv) ,19902007

HIV prevalence in general population

Estimated TB incidence

Casesper100000population/year

200

250

300

350

400

1.5

2.0

2.5

3.0

3.5

Percentage

1990 1995 2000 2005


21/87


bste tes s cesg (see bve), whe cece

tes e ct e g, s t gwth. i the a-

c, Este metee, Ee Sth-Est as

egs, the ece cece e ct s e th c-

este b ceses t sze.

Tes cece tes v g egs (Figure 1.9).

rtes e g seve e eegc sbegs

(see Annex 2 et the ctes ech sbe-

g), stbe Este Ee cesg ac c-

tes wth w evece HiV. ag the WHo egs,

cece s g sw egs excet the Ee

reg, whee t s xte stbe. Whe the te e-

s 19951999 20052007 e ce, the estte

vege te chge TB cece ( s) e 100 000

t ws stest ac ctes wth hgh HiV ev-ece the Este Ee sbeg (Figure 1.10).

The te t whch cece ws ecg swe the Ce-

t Ee sbeg , t esse extet, the Este

metee sbeg. i the the sbegs, cece

ws g t s te bth te es.

The cte the gb cece te eces

t esete the st tw ets ths sees.1 i ve-

e b the tg, the t shw tht mdG tget

6.c ws et b 2005 (cece tes eke 2004), we

he the tget te 2015.

1.2.2 pac

Thee wee estte 13.7 evet cses 2007

(206 e 100 000 t), sght ecese 13.9

2006 (tAble 1.2). o these 13.7 evet

cses, estte 687 000 (5%) wee HiV-stve. F

tes TB cece cbe wth ssts bt the

t sese eet cteges cse (Annex 2),

the gb evece TB s estte t hve bee ece

sce 1990 (Figure 1.8). Ths ece s ctst t the se

TB cece the 1990s, whch c be exe b

ecese the vege t sese s the ct

cses tete doTS ges cese, cbe wth

ctve sht t sese g HiV-stve

cses (whch hs t ceste cese the

cece HiV-stve TB cses).

reg tes TB evece 1990 t 2007 s

we s jects t 2015 (bse extt the

te 20052007) e shw Figure 1.11. pevece

hs bee ecg the Este metee reg, the

reg the aecs, the Sth-Est as reg the

Weste pcc reg sce 1990, egs e

tck t t est hve evece tes b 2015 (ev-ece hs e hve ce wth the 1990 eve

the reg the aecs). i the ac Ee

egs, evece tes cese sbstt g the

1990s, b 2007 wee st bve the 1990 eve the

ac reg jst bck t the 1990 eve the Ee-

reg. pjects cte tht ethe eg w ech

the tget hvg the 1990 evece te b 2015,

the ac reg t s ke tht evece w be

bck t 1990 eves b 2015. The g betwee the 2015 t-

gets cet evece tes these tw egs e

tht the w s whe s ke t eet the St TB

ptesh tget hvg the evece te b 2015.

1.2.3 Moay

a estte 1.32 HiV-egtve ee (19.7 e

100 000 t) e TB 2007, thee wee

t 456 000 TB eths g HiV-stve ee

(tAble 1.2).2 revss the estte be cet

cses TB tht e cecte wth HiV (seCtiOn 1.2.1;

bOx 1.1) ex wh the esttes TB eths g HiV-

stve ee e hghe th thse bshe 2008. 3

deths TB g HiV-stve ee cct 23%

the estte 2 HiV eths tht cce 2007(bOx 1.1).4

revss t esttes the be cet cses

TB tht e HiV-stve bee 2007 hve s e t w

L FIGURe 1.8goa a o tb cdc, ac ad moay,cd o wh Hiv, 19902007

Incidence (all forms, including HIV)

Cases

per100000

popu

lation/year

125

130

135

140

Prevalence (all forms, including HIV)

Casesper100000population

220

240

260

280

Mortality (including HIV)

Deathsper100000

population/year

27

29

30

31

28

1990 1995 2000 2005

1 Global tuberculosis control: surveillance, planning, fnancing. WHOreport 2007. Geneva, World Health Organization, 2007 (WHo/HTm/TB/2007.376); Global tuberculosis control: surveillance, planning,fnancing. WHO report 2008. Geev, W Heth ogzt,2008 (WHo/HTm/TB/2008.393).

2 Esttes TB eths HiV-stve HiV-egtve ee e e-sete sete becse TB eths HiV-stve ee e csses HiV eths the itet Sttstc Cssct dseses(iCd-10).

3 o the 456 000 TB eths g HiV-stve ee 2007, est-te 226 000 wee cses tht wee tete 230 000 wee tet-e cses.

4 htt://www.s.g/e/KwegeCete/HiVdt/Ee-g/testEdt.s


22/87


evss t esttes tt tes bee 2007 (bOx

1.1). F tes TB cece cbe wth ssts

bt cse tt tes g eet cteges cse

(Annex 2), the gb TB tt te (cg TB eths

HiV-stve ee) s estte t hve cese g

the 1990s; ths te ws evese the e 2000,

tt tes e w ece (Figure 1.8).

reg tes TB tt tes 1990 t 2007

s we s jects t 2015 (bse extt

the te 20052007) e shw Figure 1.12.

mtt tes hve bee ecg the Este mete-

e reg, the reg the aecs, the Sth-Est

as reg the Weste pcc reg sce 1990.The ece hs bee etve ste the reg the

aecs the Weste pcc reg, whe the ece

ws ste the Este metee Sth-Est as

egs te 2000. o these egs, thee e tck

t t est hve tt tes b 2015. i the Weste

pcc reg, the tt tget w be w sse

ess the cet te ece cceetes 2008. i

the ac Ee egs, tt tes cese

sbstt g the 1990s. athgh ths te hs bee

evese ( 2000 the Ee reg

2005 the ac eg), tt tes 2007 wee

st bve the 1990 eve the ac reg jst

bck t the 1990 eve the Ee reg. pjects

cte tht ethe eg w ece tt tes bck

t eve 1990 eves b 2015, w cet t hve

tt tes ce wth 1990. The g betwee the2015 tgets cet tt tes these tw egs

e tht the w s whe s ke t eet the St

TB ptesh tget hvg the tt te b 2015.

Cases(allforms)per100000p

opulation/year

1990 1995 2000 2005

400

350

Africa high-HIV

300

250

200

220

210

Africa low-HIV

200

190

180

50

45

Central Europe

40

35

30

100

90

Eastern Europe

80

70

60

20

18

High-income countries

16

14

12

109

108

Eastern Mediterranean

107

106

105

85

80

Latin America

75

70

65

200

195

South-East Asia

190

185

135

130

Western Pacific

125

120

170

160

150

50

60

55

50

1990 1995 2000 2005 1990 1995 2000 2005

L FIGURe 1.9td mad cdc a o, 19902007


23/87


24/87


L FIGURe 1.11po owad ach ha o ha ac y2015 comad wh h o1990, y WHO o.The -xsss stze evecetes, wth the bsee set t the1990 eve ech eg (bckhzt e) eg tgetsset t 50% the 1990 eve(e hzt e). Tes 20082015 e ecst sg exet egess estteevece tes ve the e20052007.

Standardized

prevalence

rate

1.4

1.2

1.0

0.8

0.4

AFR AMR EMR

1.2

0.8

1.0

0.6

EUR

0.9

0.8

1.0

0.7

0.6

SEAR

0.9

0.8

1.0

0.7

0.6

WPR

0.9

0.8

1.0

0.7

0.6

0.5

0.4

0.9

0.8

1.0

0.7

0.6

0.5

0.4

0.5

0.5

1 99 0 19 95 2 00 0 2 0 05 2 01 0 2010 1990 1995 200 0 20 05 2010 2010 19 9 0 19 9 5 2 0 00 2 00 5 2 01 0 2010

L FIGURe 1.12po owad ach h

a o ha moay omtb y 2015 comad wh h o 1990, y WHO o.The -xs ss stzett tes, wth the bseeset t the 1990 eve echeg (bck hzt e) eg tgets set t 50% the1990 eve (e hzt e).Tes 20082015 e ecstsg exet egess estte tt tes ve thee 20052007. mtt teseesete these ghs eexcg eths TB HiV-stve ee.

Standardizedmortalityrate

1.2

0.8

1.0

AFR AMR EMR

1.4

1.2

1.0

0.8

EUR

0.9

0.8

1.0

0.7

0.6

SEAR

0.9

0.8

1.0

0.7

0.6

WPR

0.9

0.8

1.0

0.7

0.6

0.5

0.9

0.8

1.0

0.7

0.6

0.5

0.5

0.5

19 90 19 9 5 2 0 00 2 00 5 2 01 0 2010 199 0 19 95 2000 2005 2010 2010 19 90 19 95 2 00 0 2 0 05 2 010 2010

0.6

0.6 0.4


25/87


L tABle 1.3WHO ocy acka o ma a o tb cdc,ac ad moay, 20082015 ad yod

ga1. ive svece sstes t ce ( st ) cet

cses TB cse tct t t cct ( st )TB eths vt egstt sstes.

2. Stegthe t cct t t evte the TB eec t ese gess TB ct.

3. revew te ec the t, ssts tceths se t ce WHo esttes TB cece, evece tt tes.

4. ret b Tsk Fce whethe 2015 mdG St TB pteshtgets e cheve ( t) , sht te 2015.

Ma tb cdc a5. ase ec the ebt cvege cse tct

t sg st ewk, e t estte the ttbe cet TB cses tes cece tes.

6. Cet / vte TB tct t ctes wheeses sg the st ewk shw tht TB tct te cse x (ect ese) TB cece.

7. Css-vte esttes TB cece sg TB tt t vt egstt sstes.

Ma tb ac a8. Sve the evece TB sese 21 gb cs ctes

ccg t WHo gees Tsk Fce ecets.9. pce ect esttes TB evece bse esttes TB

cece the t TB sese ctes whee sves the evece TB sese e t eete.

Ma tb moay a10. deve t vt egstt sstes t eb ec TB

eths.11. itte se vt egstt whee t vt egstt

sstes e t et vbe.12. pce ect esttes TB tt sg esttes TB

cece cse tt tes ctes wtht ebe

t se vt egstt sstes.

eaa h mac o tb coo13. Cct stes ec t evte the ct ct tes

TB cece, evece tt.

1.3 Imroving masurmn o rogrssowards h 2015 imac args:h WHO Goba task Forc on tBImac Masurmn

as exe seCtiOn 1.1, the ct tgets ecg

tes TB cece, evece tt e the cs

tet t ets t ct TB. de-

sttg whethe t the e cheve s j -

tce v ctes, the ute nts, WHo

the St TB ptesh, vet techc, c

eveet geces. The esttes TB cece,

evece tt the tes esete seC-

tiOn 1.2 e bse the best vbe t t-

c eths, bth whch wee evewe ese b

g exets -2008.1 netheess, wth bette

svece sstes, t sve t, e -eth

ss exstg svece gtc t

the eeet tc eths, these esttes

c be ve the e t 2015 ( be).Wth the excet Ete 2005, the st t-

we t-bse sves the evece TB

sese the ac reg wee etke betwee

1957 1961; ctes, sch sves hve eve

bee e (Annex 4). ntct sstes e estte

t cte 5070% cet cses st

ctes (seCtiOn 1.5), wth these sstes etg

c be cete (CHApter 2, seCtiOn 2.2.7). o 10%

the estte 1.5 TB-ttbtbe eths ( HiV-

egtve ee) 2005 wee ece vt egstt

sstes ete t WHo b agst 2008.2 The ges

the Sth-Est as Weste pcc egs, whch

cct 55% the ws TB cses, wee


26/87


t ssessg the qt cvege TB tct t.

Ths ch cssts thee ce cets (Figure

1.13). The st s ssesset the qt vbe

TB tct t; ths ces checkg the ceteess

etg (wth bechk tht 100% etg ts

sh et t ech qte) ssessg whethe thee

e cte scsse ecs. it s ces ss

the te exte csstec t sg t

sbt t. ite csstec es tht t

e csstet ve te sce (, t, tht vt

c be exe), whe exte csstec es tht t

e csstet wth exstg evece bt the eeg

TB ( exe, the t cses tht

e se-stve, the t e t ee cses) . The

ests the ss ceteess, cts, scs-

scts te exte csstec c be se s

the bss etg whee hw svece ees t

be stegthee.The sec cet the ewk cces ss

tes tct t, wth the ssessg the

extet t whch the efect tes tes TB cece

the extet t whch the efect chges the cts

(sch s gtc ets t tet e cses).

dstgshg betwee chges tht e e t cece

chges tht e e t the cts s cc whe

sg tct t t estte tes the tes TB

cece cse etect. The ss the sec

cet the ewk sh be se t etee

whethe te sees TB tcts e g x tes TB cece, the extet t whch the ee t

be jste the cts bee sg the s ese

tes TB cece. i TB tcts e g x

1 as eee t Figure 1.13. F ext, see Measuringprogress in TB control: WHO policy and recommendations [c e].Geev, W Heth ogzt, 2009 ( ess).

L FIGURe 1.13Famwok o mao ad mam o tb cdc ac daa

A daa aad com?

G cvege, wth ssg ets

n ctes

n scssct

dt te csstet

dt exte csstet

If not, iMprOveac ym

Do cha ocao o

m fc d cdc?

assess chges cse-g et cseets

assess chges TB etets

Exe hstc tc evets wth ssbect TB / etg

eaa dmoocatrenDs ad iMpACt otb coo

Do ocao

cd a cdtb ca?

Cteecte stes

a e t et whee cses best/sse

Css-vte esttes TB cece wth TBeths ece vt egstt sste

upDAte ma od

aoa, CertiFYo vAliDAte acdaa

tes TB cece, the c be se eb t ssess

whethe cece s g (mdG Tget 6.c) t.

Eve whe vbe tct t e cete

hgh qt, whe the e t be g x

tes TB cece, the e t scet t estte TB

cece bste tes. T ths, ss whethe

TB cses e beg cte c tct sstes

s eqe (s ws e st ctes whe the st

esttes the gb be TB wee ce 1997;

seeAnnex 2). The j ess wh cses e sse

c tct t hve bee ee the s-ce

e,1 ce bt es, ck tc-

t cses b bc vte ves, e cses

ccessg heth sevces t be ete s TB ssects

ck ccess t heth sevces. oet esech (sch

s cteecte stes) s we s stg evece

(sch s the kwege ctces heth-ce st

ete t et TB ssects, the extet t whch eg-ts bt tct cses e bseve -

t ccess t heth sevces) c be se t estte the

ct cses tht e ssg c tct

t. it s s ssbe t ssess the cvege tc-

t t, t css-vte esttes TB cece

ce sg the eths, b sg the be

TB eths ece vt egstt sstes.

The bjectve s tht the ests sg ths ewk

e se e tw ws. i cts TB svece

t e shw t be cse x TB cece, the t

w be cete vte s ect ese TB c-


27/87


BOx 1.3

esimaing tB incidnc using caur-rcaur mhods: an am rom egyThe nTp Egt ce evece tht st TB cses hve ccess t heth-ce sevces ve b bc vte ctes s t

t-ct et esech ject the Este metee. The be TB cses exeecg sts seekg ce

bt t beg gse s theee execte t be w. netheess, whe tets e gse tete b ves tht e t

ke t the nTp, t s ke tht the e ece c tct t. Qtg the t cses tht e gse b

-nTp ves (the extet t whch thee s e-tct) theee w e ccte estte the tt be cses

the ct s we s the t tht e beg etecte b the nTp (the cse etect te).

T ssess the extet t whch cses wee beg sse c tct t t t te esttes TB cece the cse

etect te, the mst Heth Egt tgethe wth the WHo oce the Este metee eete cteecte

st 2008. St egstes stg TB cses wee tce t eesettve se -nTp heth ctes the

vte bc sects. The st cses these egstes ws the ce wth the st te cses the se e. usg

cteecte g-e es, the be cses sse b sces ws estte b cg () the be cses bseve

ech sce t eeet wth () the be c cses g sces (tht s, the ve cses). ases wee

etke the whe se st se-stve cses .

rd ma o tb cdc ey ad o caca aay

noTiFiCaTion daTa (2007) WHo oriGinal ESTimaTES (2007) WHo rEViSEd ESTim aTES (2007)

all CaSES SS+ CaSES all CaSES SS+ CaSES all CaSES SS+ CaSES

new TB cses 9 459 4 887 17 517 7 882 15 873 6 765

rtes (e 100 000 t/e) 13 6.5 24 10.5 21 9

Cse etect te (%) 54 62 60 72

F cteecte esttes t be v, cet cts st be et. i tc, thee e sces t sh be vbe t

w jstet eeeces g the sces t. Ths ws the cse Egt: the thee vbe sces wee the nTp egst,

the st egstes vte -nTp ves the st egstes bc -nTp ves.

Bse the st ests, the cse etect te se-stve cses ws evse ws t 72% ( 62%). The cse etect te

cses ws evse ws t 60% ( 54%). S stes the ctes whee ( st ) cses hve ccess t heth

sevces c s he t evse exstg TB esttes.

BOx 1.2

esimaing tB incidnc oowing in-dh anaysis o survianc and rogrammaic daa duringh riod 19962006: an am rom Knya

The cece TB Ke ws ect estte TB tct t 1997, s t gb et t estte the gb

eegc be TB. The estte ws bse exet ssesset tht the ecetge cet se-stve cses beg

te ws 57% (.e. 57% cse etect te). ut 2006, the te TB cece bee te 1997 ws sse t be the se s

the te TB tcts ( s TB cse).

Ke hs exeece geeze HiV eec sce the e 1980s sbstt ets t ve the qt cvege TB

gss tetet sevces wee e 2001 ws. Ths e t ct t setge the eect HiV (whch ects TB

cece) the eect ge ece TB tcts, whch t e t ct t estte the te TB cece.

Betwee Setebe 2006 decebe 2007, esttes the bste ve TB cece the te TB cece wee jt

evewe b WHo the nTp. Ths ws e the ctext ew evece ew ss. The j ew sces evece wee ()

t tes HiV-stve HiV-egtve TB tcts sete () ect ese the evece HiV g TB tets

() ecet sve the evece HiV the gee t (v) evece bt hw ge ece h chge

g the e 19962006. Bth () () bece vbe wg the tct exs ve-tte HiV

testg TB tets 2005. Evece bt ge ece g the e 19962006 ws ce g 2007. The

c cts se wee: the be heth ts whee TB gss ws vbe, the be heth ts whee TB tetet

ws vbe, the be nTp st t t, vc stct eve, nTp g. F these cts, thee ws

ce etsh wth tes TB tcts 2001 t 2006, whe HiV-ete t sggeste tht the HiV eec eke

2000 h t cse cese TB cece 2001 t 2006. i cbt, these ew t ve stg evece tht the

cese TB tcts te 2001 ws e t gtc veets ( t ceses TB cece). Ths e t wwevs the estte TB cece 2006, jstet the estte te TB cece, w evs the est-

te cse etect te (t 70%). The g estte TB cece ( cse etect) 1997 ws et chge.

T w ebe eseet tes TB cece 2007 ws, tg hgh tes HiV testg TB tets s esset.

Ths w w tes HiV-stve HiV-egtve TB tcts t be sete. Tes HiV-egtve TB tcts c be se t

ese chges cse-g. Cs tes HiV-stve HiV-egtve TB tcts c be se t ssess the ct

HiV TB cece. Ets t stegthe te svece, cg the tct ew ecg etg s exe

se eectc ecg etg sstes, hve beg.

F the ets, see mse J et . new eths esttg the tbecss cse etect te. Bulletin o the World Health Organization, 2009 ( ess).


28/87


ece. i cts svece t e t ce

ct cses, ths ct w be estte

se t te esttes cece ( b extes the

cse etect te). Fgs w s be se t et

the eses eee t stegthe svece s tht the

sts eqe t t be cete vte c

be et. recet exes hw eet cets the

ewk c be eete ctce e ve

bOx 1.2, bOx 1.3 bOx 1.4.

1.3.2 Mam o ac

Thee e tw eths esttg the evece

TB. The st s ect eseet sg css-sect

t-bse sve. Sch sves e esbe

the estte evece se-stve TB s

100 e 100 000 t e (thewse the se

sze eqe t ese evece wth scet ecs

s s ge tht sve s ctc tes cst

gstcs). Eve wth the gb vege 100 cses

e 100 000 t, se sze 200 000

bget uS$ 12 s s eqe. Sce

evece tc s e qck th TB cece

esse t ct ets, sees sves ccte

t etve we tevs ( exe, 10 es) c be

ve se ctg ge chges the eeg-

c be TB hgh-be hgh-cece ctes

(ecet exes HBCs ce Ch, whee sves

wee eete 1990 2000, wth th e

2010; the phes, whee sves wee e-

ete 1997 2007, wth th e 2017).

i ctes whee the be TB s we, evece c

s be estte ect s TB cece te b the

vege t sese (Annex 2).

athgh the tte g ctes s t e-

se gess TB ct sg te-cecte sve-

ce t, the Tsk Fce hs ete 21 ctes whee

twe t-bse sves the evece TB

sese g the e 20082015 e t the

BOx 1.4

esimaing tB incidnc using moraiy daa rom a via rgisraion sysm:an am rom Brazi

WHo esttes TB cece e bse tct t, sves the sk ect, sves the evece TB sese

cbe wth esttes the vege t sese, tt t vt egstt sstes cbe wth esttes the

cse tt te. Whee seve sces evece exst, getest weght s ttche t the st ebe t. F st ctes, cece

s ect estte TB cse tct t exet ssesset the ecetge cet TB cses beg te. Whe

cse-g ets t chge ch ve te, tes TB cece e te sse t tes TB cse tct tes

(Annex 2). ut 2005, these eths wee se t estte TB cece ts te Bz.

B 2005, the mst Heth Bz h get ve the TB tct sste the eth egstt cet the vtegstt sste. Ths ce exteg cvege bth sstes thght the ct, vtg t sstetc kg

ecs wth betwee the tw tbses. lkge ecs wth the TB tct tbse eett cees

t stgsh betwee ew e-tetet tse- ecs wee se t et cte ecs. Ths shwe tht tcts

h bee tc fte tht the ce te h bee eestte (see tbe bew). rev cte ecs cese the

g betwee the be ew TB cses te the be ew TB cses estte b WHo, hghghtg the ee evew

exstg esttes.

th c o mo dca cod om h daaa o tb ca ocao, 2005

dupliCaTES rEmoVEd nEW noTiFiEd CaSES noTiFiCaTion raTE CHanGE (%) CurEd (%) CHanGE (%)

BEForE aFTEr BEForE aFTEr BEForE aFTEr

19 064 81 330 74 113 44.2 40.2 -9.7 60.5 64.5 +6.7

Esttes TB cece Bz e w bse ss TB eths ece the vt egstt sste. The cse tt tews ccte b css-kg the cse-bse TB tct tbse the tt tbse. icece 2005 ws the estte

s the be TB eths the tt tbse ve b the cse tt te (estte s the be eths the tt

tbse ve b the be cses the tct tbse, wth te jstets the t ecs bth

sstes tht c be ke jstet the cvege TB tt ecs). Sce the tt t sste ws

jge b the c thtes t hve hghe cvege th the TB tct sste, sce t s ke tht the cse tt te h

chge ke ecet es, the te cece ve te ws estte b ssg tht the te the TB cece te ws the

se s the te the TB tt te 2001 t 2005. Ths sggeste tht cece ws g t te 3.3% e e. icece

bste tes es bee 2005 ws s bse ths te (see tbe bew).

Oa ad d WHO ma o tb cdc tb moay daa, 2005

noTiFiCaTionS oriGinal ESTimaTE oF inCidEnCE rEViSEd ESTimaTE oF inCidEnCE

new TB cses 74 113 111 050 95 408

icece tct te 40 60 51(e 100 000 t/e)

Cse etect te 69% 78%


29/87


ses gb eg eseets gess

TB ct (Figure 1.14). The st ces 12 ac c-

tes s pkst bt e the e HBCs the

Sth-Est as Weste pcc egs (the excet

s i, whee sbt sves hve e bee e-

ete the sch sves e e). Ctes

wee seecte ccg t vs cte,1 cg the

estte evece se-stve TB, the she the

gb eg bes estte TB cses, the cse

etect te, HiV evece the gee t

the vbt ( t) t ee sve. Exst g

s g sves the cct techc

geces t ve ssstce wee s csee. mst

these ctes wee e ctte t the g

eett sves bee the cs the stevee b the Tsk Fce. Hweve, ths cs es

tht tc ets t st the sccess esg

eett sves these ctes e beg e

b the Tsk Fce ts tes. T te, these ets hve

ce wkshs t st 10 ctes (eght ac

ctes s pkst Th) t eve sve -

tcs csstet wth ecet gees,2 exet evew

tcs, cttg the vs vce bt Gb

F cts egg exstg gts,

ct sss.

1.3.3 Mam o moay

The best w t ese the be eths TB s

v t vt egstt sste whch eths e

ce ccg t the itet Sttstc Cssct

dseses (iCd-10), t e ve ceteess

ccc (see bOx 1.4 exe Bz). T

ke ths ssbe, ctes w ee t eve

vt egstt sste, sbstt stegthe exst-

g sste (see s Annex 4). i the ete, se

vt egstt cbe wth veb ts ve

te st. Whee ethe t se vt

egstt sstes exst, TB tt c be estte

sg esttes TB cece the cse tt te

(Annex 2).

1.3.4 sa o mac mam HbC a hd o 2008

The stts t the e 2008 the thee j cets ct eseet hghghte bve -eth -

ss te svece t; sves the evece

TB sese; ss tt ecs vt egs-

tt t sves s shw the 22 HBCs tAble

1.4.3 a -eth ss svece t ws ete

t hve bee etke b 12 ctes the st ve

es, thgh the extet t whch these ses wee

L FIGURe 1.14th 21 oa oc co wh a aoa ac o tb da y commdd h od 20082015 (d),ad dd o co m h ca (y)

1 F ext, see the Report o the second meeting o the WHOTask Force on TB Impact Measurement. Geneva, 67 December 2007.Geev, W Heth ogzt, 2007 (bshe).

2 W Heth ogzt (17 ths). Assessing tuberculosis preva-lence through population-based surveys. m, W Heth ogz-t, 2007.

3 dt the ctes wee ete bt eqe the vt bthe Tsk Fce secett.


30/87


L tABle 1.4Mam o cdc, ac ad moay cad o (20002007) ad ad (20082015)

in-dEpTH analySiS oF rouTinE prEValEnCE oF diSEaSE analySiS oF ViTal rEGiSTraTion daTa

SurVEillanCE daTa SurVEy (morTaliTy rECordS)

CarriEd ouT plannEd CarriEd ouT plannEd CarriEd ouT plannEd

1 i y y y, sbt y, sbt n n

2 Ch y y y y n n

3 ies y y y y y y

4 nge y y y n n

5 Sth ac y y y y

6 Bgesh n n y n n

7 Eth n n y n n

8 pkst n n y

9 phes n n y n n

10 dr Cg y y n n n n

11 rss Feet y y y y y y

12 Vet n y

13 Ke y y n y n n

14 Bz y n n y y

15 ur Tz y y y n n

16 ug y n n17 Zbbwe y y n n n y

18 Th y y y, sbt y n n

19 mzbqe y y n n n n

20 m y y y, sbt y n n

21 Cb n n y y n n

22 aghst n n n n n n

Hh-d co 12 14 10 14 4 5

ictes t t ve. nt sve ess thewse sece.b The st w the tbe shws the be ctes sweg es t ech qest.

e wth the ewk evee b the Tsk Fce 2008

(Figure 1.13) s t kw. Sch ses e e b

the 14 ctes, eg exceet tt t

( test) ths ewk ctce.

Sves the evece TB sese hve bee e-

tke the ve HBCs the Sth-Est as reg

(tw twe sves thee sbt sves)

HBCs the Weste pcc reg (

whch wee twe sves) betwee 2000 2007.

Wth the sves e e seve these e

HBCs,1 whch e g the 21 gb cs ctes

seecte b the Tsk Fce, the Sth-Est as Westepcc egs e tc we ce t ese ct

betwee 2000 2015. Ch s best ce t ese

whethe t the St TB ptesh tget hvg

evece betwee 1990 2015 s cheve, sce t hs

e ccte sves 1990 2000, wth th

sve e 2010. Beses the e HBCs the Sth-

Est as Weste pcc egs, the HBCs hve

ccte sve the evece TB sese sce

2000. netheess, sx the ac HBCs s we s pk-

st e g t eet sves betwee 2008

2010. Ths ces Eth; whe t the g st 21 ctes, sve ths ct w cseb

cese the she the t estte TB cses

svee the ac reg. ag the eg c-

tes shw Figure 1.14 (Gh, mw, mzbqe,

rw, Se lee Zb), excet mzbqe

Se lee hve s t eet sves sttg

2009 2010. i these e sves e t be sccess

eete, thee e seve j cheges tht ee t

be vece. These ce csg g gs2 es

cg X- eqet.

as e hghghte bve, ew HBCs hve se TB

tt sg t vt egstt sstes -

tt sves. The ctes whee tt t vt

egstt sstes hve bee se t qt TB eths

e Bz, the rss Feet Sth ac, wheies hs ccte tt sve. Ths ce

esttes the ee gee stegtheg t

t gee heth t sstes

ctes.

1 Ths ces sve e the phes 2017. The excetswhee te sves e t et e e Bgesh Vet n,whee eett twe sves ws ecet cet-e.

2 mst ctes hve ce sves Gb F ss. Hweve,

eveet st tcs hs shw tht the g eqestes te t w. regg exstg gts ct seet g s eqe. a ew ctes hve t et seceg t t the Gb F 9. The ee 9 cts s J 2009.


31/87


L tABle 1.5Ca ocao, 2007

nEW CaSES % oF nEWrE-TrEaTmEnT pulmonary

nEW and rElapSE SmEar- SmEar-nEGaTiVE/ EXTra- CaSES EXCludinG CaSES SmEar-CaSES poSiTiVE unKnoWn pulmonary rElapSE oTHEr poSiTiVEb

WHolE WHolE WHolE WHolE WHolE WHolE WHolEdoTS CounTry doTS CounTry doTS CounTry doTS CounTry doTS CounTry doTS CounTry doTS CounTry

1 i 1 295 943 592 587 398 862 206 840 179 686 60

2 Ch 979 502 465 877 430 634 36 612 66 437 52

3 ies 275 193 160 617 102 613 8 048 467 61

4 nge 82 417 44 016 32 088 4 044 3 824 58

5 Sth ac 315 315 135 604 105 631 45 738 38 304 56

6 Bgesh 147 342 104 296 23 152 16 106 82

7 Eth 128 844 38 040 43 500 45 269 899 47

8 pkst 230 468 88 747 103 629 33 986 3 632 46

9 phes 140 588 86 566 49 422 1 513 1 988 64

10 dr Cg 99 810 66 099 10 968 18 737 2 406 548 86

11 rss Feet 127 338 33 103 73 560 11 704 87 586 31

12 Vet n 97 400 54 457 17 554 18 675 944 76

13 Ke 106 438 38 360 49 869 18 032 10 285 43

14 Bz 66 759 74 757 34 211 38 444 20 566 23 065 9 318 10 318 5 224 5 704 62 63

15 ur Tz 59 371 24 520 20 521 12 526 2 721 54

16 ug 40 909 21 303 13 713 4 460 703 61

17 Zbbwe 40 277 10 583 21 964 6 381 1 137 33 18 Th 54 793 28 487 17 156 7 485 62

19 mzbqe 37 651 18 214 13 064 5 020 393 58

20 m 129 081 42 588 41 826 40 002 4 466 50

21 Cb 35 601 19 421 7 120 8 412 894 73

22 aghst 28 769 13 213 8 251 6 227 62

Hh-d co 4 519 809 4 527 807 2 120 909 2 125 142 1 605 663 1 608 162 565 135 566 135 411 996 412 476 548 57 57

aFr 1 251 642 1 251 735 561 091 561 149 408 936 408 964 223 320 223 322 74 165 792 58 58

amr 208 419 218 426 114 307 119 838 52 053 55 041 31 389 32 564 10 462 11 045 688 704 69 69

Emr 375 857 378 895 155 558 155 572 135 441 136 865 75 299 76 898 4 338 131 53 53

Eur 322 132 350 529 97 156 105 288 154 365 165 777 45 094 53 623 121 936 127 354 57 416 39 39

SEa 2 007 111 2 007 193 972 390 972 441 622 776 622 795 295 857 295 866 194 733 194 736 218 220 61 61

Wpr 1 325 173 1 365 284 656 883 666 412 529 296 548 024 78 479 88 538 73 005 77 144 951 4 438 55 55

goa 5 490 334 5 572 062 2 557 385 2 580 700 1 902 867 1 937 466 749 438 770 811 478 639 488 782 2 837 6 701 57 57

ictes ze cses te e doTS; t cses te e -doTS. Cses t ce esewhee tbe.b Execte ecetge ew cses tht e se-stve s 6580%.

1.4 Cas noifcaions

1.4.1 toa ca ocao

The 196 ctes etg t WHo 2008 te 5.6

ew ese cses 2007, whch 2.6

(46%) wee ew se-stve cses ( tAble 1.5; Figure

1.15). o these tcts, 5.5 (99%) wee

doTS ges, cg 2.6 (47%) ew se-stve cses (s 99% tt tcts se-

stve cses). The ac reg (22%), Sth-Est as

reg (36%) Weste pcc reg (25%) tgethe

ccte 83% te ew ese cses

s ts ew se-stve cses 2007.

ag ew cses ete b doTS ges

( tAble 1.5), 57% wee ew se-stve (

65% execte).

a tt 37.3 ew ese cses, 18.1

ew se-stve cses, wee te b doTS

ges the 13 es betwee 1995 (whe ebe

ecg beg) 2007.

1.4.2 Ca ocao daad y

ntcts sggegte b sex wee ete ew -

se-stve TB cses doTS ges b

170 ctes. o 2.55 tcts (99.2% tt

tcts doTS es 98.3% tcts),

1.65 wee e 0.9 wee ee, gvg

e:ee t 1:8.

The stbt the e:ee t css ge

gs the e eegc sbegs s shw

Figure 1.16. F thse ge 14 es, e e th w-

e wee etecte wth TB gb. The e:ee t ws

csstet


32/87


etecte wth TB ctes whee the evece HiV

the gee t excees 1% (Figure 1.17).

The ess hghe TB tct tes e e

est. pssbe exts ce bgceeces betwee e we cet ge gs

tht ect the sk beg ecte s we s the sk

ect gessg t ctve sese, / eeces

the scet es e we tht fece the sk

exse t TB ccess t ce (gee eeces).

The bsevt tht TB tct tes te t be e

eq betwee e we ctes wth hgh

evece HiV sts the hthess bgc -

eeces (tht c be essee b gc sess

e t HiV), bt the -bgc cts

tt e.

a tt 101 ctes ete tcts ew

cses ext TB sggegte b ge sex

(these ctes ccte 50% tt tcts

ext TB). Thee wee 195 002 e cses

180 310 ee cses, gvg e:ee t 1:1. The

t g ew ext tets s ch we

th the t se-stve TB tets (Figure 1.18);

estg the ess ths eece the -

gtc cts eqes the vestgt

esech.

i gee, thee s ee gee-bse ss t

vestgte the ge bgc, eegc, e-ghc, sc ecc vbes tht ect gee -

eets the cece tct TB.

1.5 Cas dcion ras

1.5.1 Ca dco a, a oc (DOts ado-DOts oamm)

The 2.6 ew se-stve cses te 2007

sces (tht s, doTS -doTS -

ges) eeset 64% the 4.1 estte cses

(tAble 1.2;tAble 1.6). Ths s s cese g-

e 63% 2006, wg sw cese 35% t

43% betwee 1995 2001 e cese

43% t 60% betwee 2001 2005 (Figure 1.19).

The veet tht cce betwee 2001 2007

ws ttbtbe st t ceses the bes ew

se-stve cses ete the Este metee,

Sth-Est as Weste pcc egs (tAble 1.6).

The cse etect te se-stve cses 2007( doTS -doTS ges) ws 70% the

Weste pcc reg (78%) the reg the ae-

cs (76%), we b the Sth-Est as reg (69%).

The ac reg h the west cse etect te (47%)

(tAble 1.6; Figure 1.20). The reg the aecs

the Ee reg ete the gest bes ew

se-stve cses tse doTS ges (Fig-

ure 1.20).

The 5.3 ew TB cses ( s) tht wee t-

e 2007 eeset 57% the 9.3 estte ew

cses. The cse etect te ew cses ws hghest

the Ee reg (75%), we b the reg

the aecs (71%) the Weste pcc reg (68%)

(Figure 1.20).

024

2549

5099

100

No report

Notified TB cases(new and relapse) per100 000 population

L FIGURe 1.15tco ocao a, y coy, 2007


33/87


L FIGURe 1.16s ao (M/F) y a o dmooca o, 2007

Sexratio(M/F)

Africa high-HIV

1.6

1.4

1.2

1.0

0.8

Africa low-HIV Central Europe

Eastern Europe High-income countries Eastern Mediterranean

Latin America South-East Asia Western Pacific

1.8

1.4

1.2

1.0

0.8

1.6

5

3

2

1

4

0.6

1.4

1.2

1.0

0.8

4

3

2

1

3.0

2.0

1.5

1.0

3.5

2.5

1.8

1.4

1.2

1.0

2.0

1.6

3.0

2.0

1.5

1.0

3.5

2.5

2.5

2.0

1.5

1.0

4.0

014 1524 2534 3544 45 54 55 64 65+ 014 1524 2534 3544 4554 55 64 65+ 014 1524 2534 3544 4554 55 64 65+

Age (years)


34/87


L FIGURe 1.17Do o ao (M/F) od w ma-otb ca, y Hiv dmc h a oao. tho a do 95% codc a o h ma ao wh ach Hiv dmc . Hozoa adom jwa ad o daa o o dc o-o.

Sexratio(M/F)ofnewsmear-positiveTBcases

4

0

-2

1%

Estimated prevalence of HIV in general population

L FIGURe 1.18Do dy o ao (M/F) w ma-otb ca (d) ad w amoay tb ca (y). thca do h ma ao.

L tABle 1.6Ca dco a o w ma-o ca (%), 19952007a

doTS proGrammES WHolE CounTry

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 200 5 2006 2007

1 i 0.3 0.9 1.0 1.7 6.9 12 23 30 44 56 60 64 68 37 40 37 38 46 45 49 49 53 59 60 64 *

2 Ch 15 29 32 32 30 31 31 30 43 64 80 80 80 22 34 39 34 34 34 34 33 45 65 * * *

3 ies 1.3 4.4 7.4 12 19 20 21 30 37 53 66 73 68 12 * * * * * * * * * * * *

4 nge 11 11 11 11 12 12 12 11 15 17 18 20 23 * * * * * * 15 13 * * * * *5 Sth a c 6.8 23 66 63 60 71 77 75 72 77 78 3 75 90 119 95 78 70 72 77 78 75 * *

6 Bgesh 6.4 14 18 23 23 24 26 30 35 40 54 65 66 14 21 23 26 25 26 27 31 * * * * *

7 Eth 15 20 22 24 25 31 30 30 31 31 28 27 28 * 24 * * * * * * * * * * *

8 pkst 1.0 1.7 3.7 2.0 2.8 5.2 13 17 25 38 50 67 2.5 * 13 5.4 * 9.1 13 * * * * *

9 phes 0.4 0.4 2.9 9 18 44 52 57 64 69 71 75 75 85 78 75 64 65 59 * * * * * * *

10 dr Cg 40 47 43 53 50 47 49 47 53 59 60 59 61 42 * * * * * * * * * * * *

11 rss Fee t 0.5 1.1 1.0 1.8 5.0 5.6 7.5 9.5 15 34 45 49 77 74 67 63 31 37 37 40 43 47 49 48 *

12 Vet n 30 59 78 83 83 82 84 87 86 89 84 86 82 59 77 84 85 83 * * * * * * * *

13 Ke 58 60 56 60 60 53 61 63 65 68 70 72 72 * * * * * 58 * * * * * * *

14 Bz 3.8 3.7 7.0 7.4 8.9 17 43 51 64 69 73 73 73 66 72 73 70 76 75 82 82 82 78

15 ur Tz 61 60 57 58 56 52 51 48 49 51 50 50 51 * * * * * * * * * * * * *

16 ug 60 60 60 51 47 47 47 48 47 48 51 51 56 * * * * * * * * * * *

17 Zbbwe 55 49 45 44 42 36 36 32 32 27 43 54 60 * * * * * * * * * *

18 Th 0.3 5.2 22 41 48 76 68 74 74 77 74 72 58 48 37 * * * * * * * * * *

19 mzbqe 59 55 53 53 50 47 45 45 45 46 47 49 49 * * * * * * * * * * * * *

20 m 27 27 30 34 50 60 69 78 88 102 111 116 27 30 29 * * * 61 * * * * * *

21 Cb 40 34 44 48 54 50 48 57 62 62 68 62 61 * 43 * * * * * * * * * * *

22 aghst 4.2 12 11 18 29 39 37 45 52 63 64 * * * * * * * * * * *

Hh-d co 8.4 14 17 20 23 26 31 35 43 53 60 64 65 31 36 37 38 39 39 41 42 47 56 61 64 65

aFr 23 26 30 35 37 36 37 43 45 46 46 47 47 33 43 42 47 43 41 42 44 46 47 47 47 47

amr 26 26 29 33 36 43 42 45 49 57 62 72 73 68 69 74 71 73 73 73 74 74 76 76 78 76

Emr 12 10 12 19 21 25 27 32 34 39 46 52 60 25 27 24 34 32 27 30 32 34 39 46 52 60

Eur 2.6 3.5 4.6 11 11 12 14 22 24 26 37 53 51 64 63 58 58 46 47 43 43 53 48 50 58 55

SEar 1.4 4.0 5.5 8.0 14 18 26 33 44 55 62 67 69 28 29 29 30 37 38 42 45 50 57 62 67 69

Wpr 15 28 31 33 31 37 38 39 50 65 77 77 77 36 44 48 43 44 43 43 43 52 67 78 78 78

goa 11 16 18 22 25 28 32 37 44 52 58 62 63 35 40 40 41 42 42 43 45 49 56 60 63 64

ictes t vbe. Esttes es e eccte s ew t beces vbe techqes e ee, s the e thse bshe evs.

* n t t be doTS et, ethe becse ct s 100% doTS, becse -doT S et ws eceve.

1.2

1.0

0.8

0.6

0.4

0.2

0

density

0 1 2 3 4 5Sex t (m/F)


35/87


1.5.2 Ca dco a, DOts oamm

i 2007, ve 99% te cses se-stve

TB wee doTS ges the cse etec-

t te e doTS ws 63% (tAble 1.6; Figure

1.19). Ths ws s veet ce wth

2006. nt esttes the cse etect te

ew se-stve cses sggest tht 74 ctes

et the 70% tget 2007, w 78 2006

(Annex 3). at eg eve, the cse etect te

ws west the ac (47%) Ee (51%)

egs hghest the Weste pcc reg

(77%) (tAble 1.6; Figure 1.20; Figure 1.21). The

Weste pcc reg (sce 2005) the reg

the aecs (sce 2006) e the egs t hve

exceee the 70% tget, thgh the Sth-Est

as reg (t 69%) s jst sht. The tc

w ge cse etect e doTS the E-

e reg ce wth the cse etect te

( doTS -doTS ges) s TB 75% (Figure 1.20) s exe b tw cts:

cete geghc cvege doTS ck

ehss st se csc.1

The ct tht doTS ges the a-

c reg esec ee t ve cse etect

ces wth tt cvet. Ets t ssess

veets cse etect ths eg hve

bee hee b the w te cece

ke t the se HiV ect, sch tht t

hs bee ct t setge the eect bet-

te ge ece the HiV eec ceses cse tcts (see s seCtiOn

1.3 bOx 1.2). me -eth ses exstg

svece gtc t s we s t

thcg sves the evece TB s-

ese (tAble 1.4) cte tht cse etect s

hghe th stte ths et.

L FIGURe 1.19po owad h 70% ca dco a. () oe ccesk the be ew se-stve cses te e doTS19952007, exesse s ecetge estte ew cses ech e. Cse cces shw the tt be se-stve cseste (doTS -doTS) s ecetge estte cses.(b) as () , bt ew cses (excg eses).

Casedetectionrate,smear-positivecases(%)

0

10

20

30

40

50

60

70

80

0

10

20

30

40

50

60

70

80

Casedetectionrate,allnewcases(%)

1990 1995 2000 2005 2010 2015

1990 1995 2000 2005 2010 2015

WHO target

DOTSbegins

DOTSbegins

A

B

L FIGURe 1.20pooo o mad ca od d DOts (y oo o a) ad o-DOts (d oo o h a) 2007 o (a) wma-o ca ad () a w ca.The be te cses ( thss) s shw bve ech t ech b.

(a) New smear-positive

Casedetectionrate(%)

(b) All new cases

0.1

AFR AMR EMR EUR SEAR WPR AFR AMR EMR EUR SEAR WPR0

10

20

30

40

50

60

70

80

90

0

10

20

30

40

50

60

70

80

90

Casedetectionrate(%)

WHO region WHO region

WHO target

5.5

0.018.1

0.1

9.5

0.1

9.7

3.0

28

0.1

38

561 114 156 97 972 657 1195 199 366 297 1892 1265

1 Ctes the Ee reg et sbstt bes cses wh sese s gse b eths the thst se csc. These cses e t ecessse-egtve.


36/87


athgh cse etect ew se-stve cses

doTS ges ve gb betwee 2006

2007, the ceet betwee 2006 2007 ( ext

55 000 cses) ws ess th 1%, the sest ete -

cese sce 19951996 (tAble 1.6; Figure 1.19; Fig-

ure 1.22). mst the s cese etecte cses ws

ttbtbe t i pkst ( pkst ths s ke

t ctwe ets t eve sce teshs

betwee the nTp vte ves, s escbe e

CHApter 2), t esse extet nge

Sth ac (Figure 1.23). i the Sth-Est as reg,

the cceet cse-g te 2000 ws ttbt-

be st t gess Bgesh, i, ies

m. The Weste pcc reg s te b Ch-

, whee cse-g exe betwee 2002

2005; sbseqet, tte gess hs bee e (tAble

1.6; Annex 1).

Ch i ccte estte 27%

etecte ew se-stve cses 2007. ngeccte 10% etecte cses. These thee c-

tes e g eght HBCs tht tgethe ccte 57%

ew se-stve cses t etecte b doTS -

ges 2007 (Figure 1.24).

doTS ges etecte 5.2 ew cses

2007 (99% tcts) t tt 9.27

estte cses ( tAble 1.2;tAble 1.5). Ths s eqvet

t cse etect te ( ew cses) 56% 2007,

2% cese 54% 2006.

1.6 Oucoms o ramn in

DOtS rogramms1.6.1 nw ma-o ca

a tt 2.5 ew se-stve cses wee egstee

tetet doTS ges 2006, xte

the se be tht we

Global TB Report 2009

Documents