Session 11: MDR & XDR-TB: How Can Business Help Stem the Tide? Overview of Global MDR-TB/XDR-TB Issues & Bottlenecks to Fighting the Epidemic Ernesto Jaramillo WHO/Stop TB Department
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Session 11: MDR & XDR-TB: How Can Business Help Stem the Tide?
Overview of Global MDR-TB/XDR-TB Issues & Bottlenecks to Fighting the Epidemic
Ernesto JaramilloWHO/Stop TB Department
Definitions of TB, MDR-TB, XDR-TB
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
TB MDR-TB XDR-TBSource of data: - TB: best performing NTP from HBCs- MDR-TB: average from GLC-approved sites- XDR-TB: well performing MDR-TB treatment programme in absence of HIV
Estimated number of
cases
Estimated number of
deaths
1.3 million* 9.37 million
440,000
All forms of TB
Multidrug-resistant TB (MDR-TB)
HIV-associated TB 1.4 million (15%) 0.52 million
The global burden of TB in 2008
*excluding deaths among HIV+ people
>150,000
1990 1995 2000 2005
Rat
e pe
r 10
0,00
0 po
pula
tion
150
145
140
135
130
125
120
TB incidence rates falling globally after peak in 2004
Peak in 2004
World as a whole on track to achieve MDG target 6.c
M/XDR-TB 2010 global report on surveillance and response
• Detection & Diagnosis– Only 7% of all estimated; US$87 million
EXPAND-TB project scaling-up access in 27 countries
• Treatment Success – 60% !
• Country response– 20/27 high MDR-TB countries
strengthening MDR-TB components of TB control national plans
Trends of MDR-TB cases in selected settings
Orel Oblast, Russian Federation Tomsk Oblast, Russian Federation
New MDR-TB cases
0
10
20
30
40
50
1994 1996 1998 2000 2002 2004 2006 2008
Year
Cas
es n
otifi
ed
New MDR-TB cases
0
20
40
60
80
100
1994 1996 1998 2000 2002 2004 2006 2008
YearC
ases
not
ified
MDR-TB epidemic: Global challenge
440,000 estimated cases in
2008 Countries report treatment, standard unknown (7%, including GLC programmes)
No treatment reported. Some treatment probably obtained, quality unknown
7%
3%
Treated in GLC approved programmes
*Based on Global MDR/XDR-TB Response Plan, 2007, updated for high-level Ministerial meeting on MDR/XDR-TB in Beijing, April 2009
27 high MDR-TB burden countriesProgress of MDR-TB care very slow
0
50
100
150
200
250
300
350
400
2007 2008 2009 2010 2011 2012 2013 2014 2015
Nu
mb
er
of
pa
tie
nts
(th
ou
sa
nd
s)
Global Plan*
Actual or expected progressTo reach targets, scale-up required in India, China and Russian Federation in particular
We have political commitment from national governments
High-level policy changes are fundamental! World Health Assembly,
May 2009…
In addition to high quality DOTS...
1. Remove financial barriers (UHC)2. Ensure well trained and sufficient human
resources3. Establish a network of labs where rapid tests
are also available4. Ensure availability of quality drugs5. Regulate the use of all anti-TB drugs6. Introduce infection control7. Establish proper surveillance8. Promote Research & Development9. Address social determinants and risk factors10. Mobilize resources domestically and
internationallyDocument WHA 62.15, 2009
Countries, WHO and the Stop TB Partnership have strong partners, but…
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