World TB Day 2017 - presentation

World TB Day 2017

TB/HIV co-infections soaring across Europe in five years

© Carl Cordonnier © Maxim Dondiuk© Andrei Dadu

Some good news across the board

Key progress:• full-scale programmes• fewer new TB cases per year• more people treated successfully• more drug-resistant patients diagnosed• almost all drug-resistant patients put on

treatment• increase in MDR-TB treatment-success

rate

Key indicators 2011 2015

Approach to drug-resistant TBSmall-scale

pilot projects

Nationwide integrated

programmes

TB notification rate/100 000 40 36Drug-susceptible success rate (%) 72 76MDR-TB detection rate (%) 30 63

MDR-TB treatment coverage (%) 63 Universal coverage

MDR-TB success rate (%) 48 51

Source: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.

TB deaths are decreasing

20002002

20042006

20082010

20122014

20162018

20200

2

4

6

8

10

3.52.7

Estimated TB mortality rate Projection 2016-2020

Rate

per

100

000

pop

ulati

on

–8.5% yearly in TB deaths between 2011 and 2015

If current trend continues, the targeted death rate of

2.7/100 000 will be achieved by 2018

on trackSource: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.

New TB cases are decreasing

19901992

19941996

19982000

20022004

20062008

20102012

20142016

20182020

0

10

20

30

40

50

29.224.6

Notification rate (all countries)Projected if current trends continuesTarget

Rate

per

100

000

pop

ulati

on –4.7% yearly in new TB cases between 2011 and 2015

If current trend continues, the targeted

notification rate of 24.6/100 000 will be achieved by 2019

on trackSource: Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe.

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

0

1

2

3

4

5

6

7

8

9

10

3.6

0.54

Estimated TB/HIV mortality rate Estimated TB mortality rate

Rate

per

100

000

pop

ulati

on

3.6% annual increase between 2011

and 2015

–8.5% yearly between 2011 and 2015

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

0

10

20

30

40

50

60

70

80

3

36

Estimated TB/HIV rate Estimated TB incidence rate

Rate

per

100

000

pop

ulati

on

–4.3% yearly between 2011 and 2015

6.2% annual increase between 2011 and

2015

TB deaths and new cases going down:TB/HIV deaths and new TB/HIV cases rising sharply

TB and TB/HIV mortality, WHO European Region, 2000–2015

TB and TB/HIV incidence, WHO European Region, 2000–2015

Source: 1. Tuberculosis surveillance and monitoring in Europe 2017. European Centre for Disease Prevention and Control / WHO Regional Office for Europe. 2. Global TB report 2016. WHO

Improved treatment success in all TB patient groups except for those who are HIV positive

Treatment-success rates were raised to 76% and 51% in new and MDR-TB cohorts respectively, a remarkable turning point for the WHO European Region, which has seen a decline since the beginning of the millennium.

Treatment outcomes, WHO European Region, 2011 data

New TB/HIV MDR-TB

6753 49

Treatment outcomes, WHO European Region, 2015 data

New TB/HIV MDR-TB

76

4151

Not evaluatedLost to follow-upFailedDiedSuccess


No reason for complacency

323 000 peopleIN WHO EUROPEAN REGION FELL ILL LAST YEAR FROM TB

32 000 people

DIE FROM TB

Every 15 minutes


TB can affect anybody at any time,but some people are more affected than others

New TB cases per 100 000 population, WHO European Region, 2015


Who are tuberculosis patients?

Of the estimated 323 000 new TB patients in 2015 in WHO European Region:

25 000

are children

111 000 are females190 000

are males

8%

34%

58%


0–4 years

5–14 years

15–24 years

25–44 years

46–64 years

over 64 years

1%

3%

11%

45%

29%

11%

TB cases by age groups, %, WHO European Region, 2015

Almost one in two TB patients is an adult


Dr Zsuzsanna JakabWHO Regional Director for Europe

The flare-up of TB/HIV co-infections from 2011 to 2015, together with persistently high rates of drug-

resistant TB, seriously threaten progress made towards TB elimination that European and world

leaders have committed to achieve by 2030.

One in three people co-infected with TB/HIV does not know about their status, which drastically

lowers their chances of being cured. In turn, this favours the spread of the diseases, putting health

systems and governments under pressure.

TB/HIV co-infection has soared in Europe in five years

HIV and TB create a deadly synergy

Between 2011 and 2015, the percentage of TB/HIV co-infection

rose from 5.5% to 9%2011 2012 2013 2014 2015

0

20

40

60

80

100

0.0

2.0

4.0

6.0

8.0

10.0

5.56.1

7.8 8.09.0

71.377.9

85.9 88.9 88.0

HIV testing coverage and percentage of HIV positive among TB patients, WHO European Region, 2011–

2015

Percentage of HIV among TB HIV testing coverage

% %


HIV and TB create a deadly combination• About 88% HIV testing coverage among 230 000

new TB cases and relapses

• 61% of 27 000 estimated TB/HIV cases were detected

• Of which only 5 818 (36%) were offered antiretroviral treatment (ART)

• Treatment success of 41% is the lowest ever

HIV testing coverage

TB/HIV case detection

ART coverage Treatment succes

88%

61%

36% 41%

Cascade analysis of TB/HIV case detection, ART coverage and outcomes*, WHO European Region, 2015

* No data from RUS,otherwise 64% No data from RUS


14

People with TB/HIV are seven times at higher risk of failing treatment and three times at higher risk of dying than people with TB disease

Success Died Failed Lost-to-follow up Not evaluated

77%

7% 4% 5% 7%

41%

21%28%

7% 3%

HIV negativeHIV positive

Treatment outcomes of new TB and relapses by HIV status, WHO European Region, 2015


Europe’s TB burden is among the lowest in the world, but the number of new MDR-TB cases is the highest

AFR

AMR

EMR

EUR-

53

EUR-

18HP

C

SEAR

WPR

Glob

al0

50

100

150

200

250

300275

27

116

36

65

246

86

142

TB incidence, WHO regions, 2015

per 1

00 0

00 p

opul

ation

AFR

AMR

EMR

EUR-

53

EUR-

18HP

C

SEAR

WPR

Glob

al

-

5

10

15

20

25

30

35

11.0

1.1

6.0

14.0

31.4

10.0

5.57.9

MDR-TB incidence, WHO regions, 2015

per 1

00 0

00 p

opul

ation


Tajikis

tan

Belarus

Rep Mold

ova

Uzbek

istan

Ukraine

Kyrgyzs

tan

Russian

Federa

tion

Somalia

Kazak

hstan

Azerbaij

anPeru

WHO Europe

World

0

25

50

75

100

7769 69

63 58 56 5347 43

2921

48

2114

37 3224 25

3222

9

2513

616

4

Percentage of MDR-TB among re-treatmentsPercentage of MDR-TB among new cases

Perc

enta

ge o

f MDR

-TB

MDR-TB in new TB cases occurs four times more often in Europe than in the rest of the world


74 000 drug-resistant TB cases in WHO European Region, 2015

43 000 (60%) drug-resistant TB cases detected and enrolled on treatment, 2015

21 800 (51%) drug-resistant TB cases started treatment in 2013 with successful outcome

Only about 60% of MDR-TB patients are detected


MDR-TB is one of key drivers of the TB epidemic in Europe

a r e f o u n d w i t h MDR TURBERCULOSIS

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


For the first time, more MDR-TB patients were successfully treated in 2015, but new cases continue to rise

2011 2015

14%18%

48%52%

MDR-TB in new cases

MDR-TB treatment success rate


In 2015, about one in four MDR-TB patients had XDR-TB

XDR-TB is more difficult to treat than MDR-TB

Extensively drug-resistant TB is on the rise

2011 2012 2013 2014 2015

12%9%

13%

18%

23%Percentage of XDR-TB among detected MDR-TB cases,

WHO European Region, 2015


Prioritized country work

We are:– building better capacity, including on early diagnosis and treatment of

TB patients

– expanding pilot projects on good TB practice to be adapted to other settings

– scaling-up innovative tools on e- and digital health to improve TB surveillance and monitoring and person-centred service delivery

– strengthening collaborations with partners, including civil society organizations, for holistic TB prevention and care.

What countries need to act upon The TB Action Plan for Europe, 2016–2020Vision: an end to the TB epidemic with zero affected families facing

catastrophic costs due to TBGoal: to stop the spread of drug-susceptible and drug-resistant TB by achieving universal access to prevention,

diagnosis and treatment in all Member States of the WHO European Region

Targets:35% reduction in TB deaths

25% reduction in TB incidence rate75% treatment success rate among the MDR-TB patient

cohort

Key strategic directions

1. Full scale-up of rapid diagnosis

2. Rapid uptake of new medicines

3. Expanding patient- and person-centred care

4. Shorter and more effective treatment regimens

5. Research for new tools

6. Intersectoral approach to address inequities

The way forward

1. Intensify country work (diagnosis, treatment and care with a focus on TB/HIV co-infection through integrated TB/HIV health services)

2. Boost exchange of good practices

3. Scale-up research and innovation

4. Foster full implementation of national action plans

5. Scale-up to full functioning of regional platforms and initiatives

6. Improve preventive treatment (that is, of latent TB infection), scale-up shorter regimen and rational use of new medicines

7. Continue policy dialogue

8. Present progress report at 68th session of WHO Regional Committee for Europe

World TB Day 2017

Thank youwww.euro.who.int/tb

© Carl Cordonnier © Maxim Dondiuk© Andrei Dadu

World TB Day 2017 - presentation

Health & Medicine