World TB Day 2000 Forging New Partnerships to Stop TB Produced by the [ Stop TB Initiative ] Coordinating Team: WHO.

World TB Day World TB Day 20002000

Forging New Partnerships to Forging New Partnerships to Stop TBStop TB

World TB Day World TB Day 20002000

Forging New Partnerships to Forging New Partnerships to Stop TBStop TB

Produced by the [ Stop TB Initiative ] Coordinating Team: WHO

11/01/00 2Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

Leading infectious killers (1998 estimate)

Leading infectious killers (1998 estimate)

Est

imat

ed D

eath

s (m

illi

ons)

< 5 years old

> 5 years old

0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

ARI AIDS Diarrhoea TB Malaria Measles

11/01/00 3Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

Magnitude of the TB Magnitude of the TB ProblemProblem

Magnitude of the TB Magnitude of the TB ProblemProblem

16–20 million prevalent TB cases globally

8 million new TB cases annually

2 million TB deaths annually (including TB-HIV)

TB is the biggest killer of people with HIV/AIDS

TB is the largest cause of death among womenof reproductive age

11/01/00 4Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

TB - Where and TB - Where and WhoWho

TB - Where and TB - Where and WhoWho 95% of new cases and 98% of deaths occur

in developing countries—TB affects the poorest and most vulnerable

75% of TB infections and death occur in the 15–54 year age group —economically the most productive group in the population

26% of avoidable deaths in developing countries are due to TB

11/01/00 5Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

DOTS Progress in DOTS Progress in 19981998

DOTS Progress in DOTS Progress in 19981998

43% of the global population had access to DOTS, double the fraction reported in 1995

119 countries have adopted DOTS—21% of global TB patients were treated under DOTS, double the fraction reported in 1995

220,000 additional cases of TB were reported globally compared with 1997

11/01/00 6Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

What is DOTS ?What is DOTS ?What is DOTS ?What is DOTS ?Directly Observed Treatment, Short-course (DOTS) has 5 key elements :

Government commitment to sustained TB control

Detection of infectious cases using sputum-smear microscopy

Standardized, short-course chemotherapy of 6 to 8 months with direct observation of treatment

Reliable supply of high quality drugs

Information systems for monitoring and recording of treatment outcome

11/01/00 7Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

AchievementsAchievementsAchievementsAchievements

1991 19951998

Countries adopting DOTS 10 70 119

TB patients under DOTS 1% 10% 21%

Average drug cost $40–60 - $10–20

External aid to TB $16 mil. - ~ $100mil.

11/01/00 8Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

Impact of TB on Impact of TB on FamiliesFamilies

Impact of TB on Impact of TB on FamiliesFamilies

A mother’s death significantly increases a child’s risk of dying

In India, 75% of urban and 67% of rural households went into debt

In India, 11% of children were withdrawn from school and 8% entered work. Around 300,000 children leave school every year due to TB

Each year in India, more than 100,000 women are rejected by their families

11/01/00 9Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

Economic Impacts Economic Impacts of TBof TB

Economic Impacts Economic Impacts of TBof TB

A TB patient loses on average 3 to 4 months of work time

20% to 30% of a TB patient’s annual household income is lost due to lost earnings

About 15 years of income are lost from premature death

In South Africa, lost earnings due to TB are estimated at 16% of GDP per capita

(Floyd et al., British Medical Journal, 1997) These substantial indirect costs borne by patients and their families are

often greater than the direct treatment costs to the health sector

11/01/00 10Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

TB/HIV - The Dual TB/HIV - The Dual EpidemicEpidemic

TB/HIV - The Dual TB/HIV - The Dual EpidemicEpidemic

Globally, 11 million people are currently infected with TB and HIV

HIV is responsible for 15% of all new cases of TB globally In some African countries, 80% of TB patients also have

HIV TB is the single largest killer of people with HIV TB treatment is equally effective in HIV+ and HIV- people.

It increases their length and quality of life and benefits their families and communities

11/01/00 11Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

Multi-drug Resistance Multi-drug Resistance (MDR) TB(MDR) TB

Multi-drug Resistance Multi-drug Resistance (MDR) TB(MDR) TB

Poorly functioning TB programmes create MDR TB

DOTS prevents development of MDR TB

MDR TB has been identified in all continents

MDR TB treatment costs around 100 times more than treatment for non-MDR TB

11/01/00 12Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

Multi-drug Resistance Multi-drug Resistance (MDR) TB(MDR) TB

Multi-drug Resistance Multi-drug Resistance (MDR) TB(MDR) TB

MDR-TB is defined as the resistance to the two most important anti-TB drugs, Isoniazid and Rifampicin.

MDR-TB occurs when:- The wrong drugs or combination of drugs

are prescribed

- The right drugs are not taken consistently

- The right drugs are not taken for the entire6 months of treatment

11/01/00 13Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

Human Rights Human Rights ViolatedViolated

Human Rights Human Rights ViolatedViolated

A cure for TB exists. Providing treatment for people with TB saves lives and protects their right to health.

TB patients and their families are often stigmatized and discriminated against

More than twice as many TB cases are reported in males than females due, in part, to gender differences in access to health

People with infectious TB infect on average 10–15 people every year just by breathing the air

11/01/00 14Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

TB impacts on Human TB impacts on Human DevelopmentDevelopment

TB impacts on Human TB impacts on Human DevelopmentDevelopment

TB deprives people of their right to the highest attainable standard of physical and mental health

TB blocks peoples’ choices and traps them in a vicious cycle

of poverty and disease

11/01/00 15Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

Household Coping Household Coping StrategiesStrategies

Household Coping Household Coping StrategiesStrategies

Selling productive assets reduces the economic prospects of the household

Removing children from school to help at home and save school fees seriously undermines their education and opportunities in life

Reducing intake of proper food increases the risk of contracting other diseases

Diverting resources for TB from other health care needs further increases vulnerability to disease

11/01/00 16Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

DOTS: A Cost-effective DOTS: A Cost-effective SolutionSolution

DOTS: A Cost-effective DOTS: A Cost-effective SolutionSolution

Requires between US $ 1 and US $ 4 per discounted year of life saved (In low-income countries)

Could cut by 50% the current potential national economic loss from TB (Ahlburg, 1999)

Could lead to a US $ 55 return over 20 years for every dollar invested

(Ahlburg, 1999 - Simulations for Indonesia)

11/01/00 17Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

Challenges aheadChallenges aheadChallenges aheadChallenges ahead How to expand DOTS coverage

from 21% in 1998 to 70% by 2005?

How to sustain the targets once they are achieved?

How to ‘Build new Partnerships’ and link TB control to health sector and social development?

11/01/00 18Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

Forging new Forging new Partnerships...Partnerships...Forging new Forging new

Partnerships...Partnerships...… to reach beyond the TB community and mobilize

new constituencies affected by TB such as:

Women's organizations Human rights groups HIV/AIDS groups Businesses

11/01/00 19Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

Forging new Forging new PartnershipsPartnershipsForging new Forging new PartnershipsPartnerships

Why TB should matter to women's organizations TB causes more deaths among women than all causes of maternal mortality

combined Over 900 million women are infected with TB world-wide, 1 million will die and 2.5

million will get sick this year from TB, mainly between the ages of 15 - 44. There are many barriers for women to access health services. They are often

unable to leave their family and work or need permission from their family. Many women lack the money for visiting the clinic or pay for treatment.

Women often end up carrying the burden of housework and their own sickness. By curing a women of TB, a life is saved and her husband and children are protected. Children suffer when the mother is sick and are at risk of contracting TB.

In many places, the stigma attached to TB leads to isolation, abandonment and divorce of women.

11/01/00 20Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

Forging new Forging new PartnershipsPartnershipsForging new Forging new PartnershipsPartnerships

Why TB should matter to HIV/AIDS groups TB is curable - TB treatment is as effective in HIV positive people as it is in HIV

negative people Curing TB can prolong the life and improve the quality of life of an HIV positive

person, such as a young mother. HIV/AIDS groups can encourage HIV positive people to get tested for TB and help

HIV positive people complete their TB treatment Curing TB in an HIV positive person protects other HIV positive people from

contracting TB and reduces the risk of MDR TB Respecting and promoting the right’s of people with TB and HIV and reducing

stigma makes it easier for them to get informed and tested which can reduce the further spread of the infections

11/01/00 21Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

Forging new Forging new PartnershipsPartnershipsForging new Forging new PartnershipsPartnerships

Why TB should matter to Human rights groups TB is curable - DOTS is an effective treatment strategy to cure TB. Human rights groups can make information available about TB

treatment, can lobby for access to affordable and effective treatment and encourage people to get tested and complete TB treatment.

Promoting and respecting human rights, including the rights of people with TB, is the prerequisite for health and development

11/01/00 22Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

Forging new Forging new PartnershipsPartnershipsForging new Forging new PartnershipsPartnerships

Why TB should matter to businesses75% of TB infections and death occur in the 15–54 year age group —economically the most productive group in the populationA TB patient loses on average 3 to 4 months of worktime In Uganda, 80% of wage earners had to stop work because of their illnessTB is curable - DOTS is an effective treatment strategy to cure TB. People with TB, who receive treatment can continue their work. Businesses should encourage their employees to get tested and help employees with TB to complete their TB treatment.

11/01/00 23Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO

Regional Distribution of Regional Distribution of Tuberculosis in 1990, 1995 Tuberculosis in 1990, 1995

and 2000and 2000

0

500

1000

1500

2000

2500

3000

3500

4000

1990 1995 2000

South-East Asia Western Pacific (b) Africa East. Mediterranean

Americas (a) East. Europe Indust. countries

Est

ima

ted

TB

cas

es i

n t

ho

usa

nd

s

(b) excludes Japan, Australia, New Zealand(a) excludes USA and Canada WHOWHO