tb activist toolkit - tb/hiv epidemiology and impact [powerpoint slides]
DESCRIPTION
The “TB/HIV Epidemiology and Impact ” provides activists with an understanding of the epidemiology of TB and TB/HIV, how the two diseases impact one another, and the need to advocate for TB/HIV collaboration. The facilitator notes and slide set are teaching tools that can be used as is or modified to suit your needs and audience.TRANSCRIPT
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Treatment Action GroupTB/HIV Advocacy Toolkit
MODULE TWO TB/HIV Epidemiology & Impact
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Topics to be covered Global and regional estimates of TB, HIV and TB/HIV coinfection
How do TB and HIV impact one another?
What are the recommended TB/HIV collaborative activities?
Advocacy priorities
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Section 1:Global & regional
statistics
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Global estimates of TB It is estimated that one-third of the world is infected with TB
There were an estimated 9.4 million new cases of TB in 2008 – An estimated 1.4 million (16%) were HIV positive
– 3.6 million were among women There were an estimated 1.8 million deaths - equal to 4,500 deaths per day– 500,000 of which occurred among people with HIV - TB accounted for nearly 25% of all HIV deaths
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Global TB estimates - 2007-08
Estimated number of new cases
Estimated number
of deaths
1.8 million1.8 million9.4 million9.4 million
~150,000 500,000
All forms of TB Greatest number of cases in Asia; greatest rates per capita in AfricaMultidrug-resistant TB (MDR-TB)
Extensively drug-resistant TB (XDR-TB) ~50,000 ~30,000
HIV-associated TB 1.4 million (16%)
500,000Based on data from WHO Stop TB Department
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Estimated new TB cases (all forms) per 100 000 population
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2009. All rights reserved
No estimate
0-24
50-99
>= 300
25-49
100-299
Regional TB incidence - 2007
Based on data from WHO Stop TB Department
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22 High TB-burden countries
1. Afghanistan 2. Bangladesh 3. Brazil 4. Cambodia 5. China 6. Democratic
Republic of Congo
7. Ethiopia 8. India 9. Indonesia 10. Kenya 11. Mozambique 12. Myanmar 13. Nigeria 14. Pakistan 15. Philippines 16. Russian
Federation 17. South Africa 18. United Republic
of Tanzania 19. Thailand 20. Uganda 21. Viet Nam 22. Zimbabwe
Based on data from WHO Stop TB Department
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What is MDR-TB? And XDR-TB?
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MDR/XDR TB
Multi-drug resistant TB (MDR-TB) is a form of TB that is resistant to isoniazid and rifampicin, two of the most powerful first-line drugs.
Extensively drug resistant TB (XDR-TB) is resistant to isoniazid and rifampicin as well as any of the flouroquinolones (e.g. oxofloxacin, levofloxacin) and at least one of the second-line injectables (amikacin, capreomycin or kanamycin).
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0.00 - 0.991.00 - 2.993.00 - 5.996.00 – 10.00>10.00No data
* Sub-national coverage in India, China, Russia, Indonesia.
MDR-TB among new cases 1994-2007
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2006. All rights reserved
Global estimate: about 500,000 new MDR-TB cases a year
Based on data from WHO Stop TB Department
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Czech Rep.
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
WHO 2005. All rights reserved
Ecuador
Georgia
Argentina
Bangladesh
Germany
Rep of Korea
Armenia
Russian Fed.
South Africa
Portugal
Latvia
Mexico
Peru
USA
Brazil
UK
Sweden
Thailand
Chile
Spain
China, Hong Kong SAR
France
Japan
Norway
Canada
Italy
Netherlands
Estonia
Lithuania
Ireland
RomaniaIsrael
Azerbaijan
Poland
Slovenia
India
Australia
Mozambique
Vietnam
Ukraine
Moldova
Philippines
Botswana
Nepal
Islamic Rep. of Iran
Lesotho
Swaziland
Namibia
Countries with confirmed XDR-TB - 2007
Based on information from WHO Stop TB Department
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Global HIV/AIDS estimates 2008
Based on data from WHO/UNAIDS
Number of people with HIV: 33.4 million (31.1 - 35.8 M)
New HIV Infections: 2.7 million (2.4 - 3.0 M)
Deaths due to HIV : 2.0 million (1.7 - 2.4 M)
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Total: 33.4 million (31.1 – 35.8 million)
Western & Central Europe
850 000850 000[710 000 – 970 000][710 000 – 970 000]
Middle East & North Africa310 000310 000
[250 000 – 380 000][250 000 – 380 000]
Sub-Saharan Africa22.4 million22.4 million
[20.8 – 24.1 million][20.8 – 24.1 million]
Eastern Europe & Central Asia
1.5 million 1.5 million [1.4 – 1.7 million][1.4 – 1.7 million]
South & South-East Asia3.8 million3.8 million
[3.4 – 4.3 million][3.4 – 4.3 million]
Oceania59 00059 000
[51 000 – 68 000][51 000 – 68 000]
North America1.4 million
[1.2 – 1.6 million]
Latin America2.0 million2.0 million
[1.8 – 2.2 million][1.8 – 2.2 million]
East Asia850 000850 000
[700 000 – 1.0 million][700 000 – 1.0 million]Caribbean240 000
[220 000 – 260 000]
Adults and children estimated to be living with HIV - 2008
Based on data from WHO/UNAIDS
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The Overlap between TB and HIV
TB infection HIV infection
11 million (TB and HIV co-infected)
2 billion
33 million
Based on data from WHO Stop TB Department
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Estimated HIV prevalence in new TB cases, 2008
Based on data from WHO Stop TB Department
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63 High TB/HIV-burden countries
Africa Region: Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Cote d'Ivoire, Congo, DR Congo, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Mali, ,Malawi, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sierra Leone, South Africa, Somalia, Swaziland, Togo, UR Tanzania, Uganda, Zambia and Zimbabwe. (38 countries)
East Mediterranean region: Djibouti and Sudan. (2 countries) American region: Bahamas, Barbados, Belize, Brazil, Dominican
Republic, Guatemala, Guyana, Haiti, Honduras, Jamaica, Suriname, Panama and Trinidad & Tobago. (13 countries)
South East Asia Region: India, Indonesia, Myanmar and Thailand. (4 countries)
Western Pacific region: Cambodia, China and Viet Nam. (3 countries)
European region: Ukraine, Russian Federation and Estonia. (3 countries)
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Section 2: TB/HIV impact
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How do TB and HIV impact one another?
People who are coinfected with TB and HIV are at increased risk for:– Progressing from latent TB infection to active TB disease
– Progressive primary TB disease (skipping over latent TB infection)
– TB recurrence (a second episode of TB)– Smear-negative TB (low baciliary load)– Extrapulmonary TB (TB outside of lungs)
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How do TB and HIV impact one another?
VaccinesBCG is not recommended for HIV-positive children
DiagnosticsThe most commonly used TB diagnostic tools lack the sensitivity to detect smear-negative and extrapulomary TB
TreatmentDifficult to dose anti-TB treatment and ARVs at the same time
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Section 3: TB/HIV Collaborative activities
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The Interim Policy for Collaborative Activities
The overall goal is to
decrease the burden of TB and HIV in dually affected population.Objectives:1. Establish the mechanisms for collaboration between TB and HIV/AIDS programmes. 2. Decrease the burden of TB in PLWHA. 3. Decrease the burden of HIV in TB patients.
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Collaborative TB/HIV activities
A. Establish the mechanism for collaboration– A.1. TB/HIV coordinating bodies– A.2. HIV surveillance among TB patient– A.3. TB/HIV planning– A.4. TB/HIV monitoring and evaluation
B. To decrease the burden of TB in PLHIV (Three Is)– B.1. Intensified TB case finding (ICF)– B.2. Isoniazid preventive therapy (IPT)– B.3. TB infection control (IC)
C. To decrease the burden of HIV in TB patients– C.1. HIV testing and counselling– C.2. HIV preventive methods– C.3. Cotrimoxazole preventive therapy
(CPT)– C.4. HIV/AIDS care and support– C.5. Antiretroviral therapy to TB
patients.
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Trends in TB/HIV collaborative services
from 2003-2008
% of TB tested for HIV
% of estimated TB/HIV detected
% of PLHIV screened for TB
% of PLHIV placed on IPT
2003 4% 2% 0.0% 0.026%
2004 3% 3% 0.3% 0.038%
2005 8% 7% 0.6% 0.081%
2006 12% 14% 1.0% 0.084%
2007 20% 23% 1.9% 0.089%
2008 22% 25% 4.1% 0.145%
Based on data from WHO Stop TB Department
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HIV testing and treatment- 2008
Region
% of TB patients tested for HIV
% of tested TB patients HIV positive
% of identified TB patients on CPT
% of identified TB patients on ART
AFR 45 46 73 30AMR 49 15 36 67EMR 5.4 4.1 39 55EUR 79 3.3 61 29SEAR 4.1 18 54 35WPR 11 7 55 28Global
22 26 71 32
Based on data from WHO Stop TB Department
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Section 4: Advocacy Priorities
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Advocacy priorities At the national and global levels, AIDS control and TB
control programs both programs need to address TB/HIV coinfection– People with HIV need to be routinely screened for TB and
given appropriate treatment– People with TB or at risk for TB should be counseled and
tested for HIV, and be offered appropriate treatment
HIV activists need to become science-based activists for TB research, treatment, and policy so that we can contribute to increased resources and political support for TB and TB/HIV.– It is expected that there will be a funding shortfall for
TB of US$2.1 billion in 2010– Current tools to prevent, diagnose and treat TB are not
sufficient• BCG vaccine is not recommended for use in HIV-positive children;
• The most commonly used diagnostic tool (smear microscopy) misses up to 50% of cases in people with HIV; and
• Some of the most powerful anti-TB medications cannot be used in conjunction with ARVs.