tb epidemic and progress towards the millennium
TRANSCRIPT
Haileyesus GetahunStop TB Department, WHO
Geneva, Switzerland
TB epidemic and progress towards the Millennium Development Goals
Open Forum 4: Key issues in TB Drug Development, August 18, 2010, Addis Ababa, Ethiopia
Outline of presentation
• Global TB epidemiology
• Global TB targets for 2015
• Progress towards global TB targets
• Moving beyond 2015
• Conclusion
Estimated number of
cases
Estimated number of
deaths
1.3 million*(range, 1.1–1.7 million)
9.4 million(range, 8.9–9.9 million)
0.5 million
All forms of TB
Multidrug-resistant TB (MDR-TB)
HIV-associated TB 1.4 million (15%)(range, 1.3–1.6 million)
0.52 million(range, 0.45–0.62 million)
The global burden of TB in 2008
*excluding deaths among HIV+ people
~ 0.15million
Highest incidence rates in Africa
Linked to high rates of HIV infection:78% of estimated HIV+ TB cases in Africa
Estimated HIV prevalence in new TB cases, 2008
Most TB cases are still in Asia
South-East Asia
34%
Africa30%
Western Pacific
21%
EMR7%
Europe4%
Americas3%
55% cases in Asia
1.Millennium Development Goals Halt and reverse incidence of TB(MDG 6, Target 6.c)
2. Stop TB Partnership targets
Halve 1990 prevalence and mortality rates (per 100 000 population)
Prevalence target: <148/100,000 (164 in 2008)
Mortality target: <14/100,000 (20 in 2008)
Global TB targets set for 2015
1.Detect 84% of smear-positive cases, and successfully treat 87% of them, by 2015
2. TB/HIV (2010) 85% TB patients tested for HIV by 2010 320,000 HIV+ TB patients received ART by 2010
3.X/MDR-TB (2015) 80% (~400,000) cases diagnosed and treated
4.Financing US$5–9 billion per year for TB control, 2010–2015
Additional targets in the Global Plan
Nine TB epidemiological regions Africa (High HIV and Low HIV) Europe (Central and Eastern) Established market economies (the rich countries) Eastern Mediterranean South East Asia Western Pacific
Incidence, prevalence and mortality targets Traffic light analogy (red, yellow and green)
Progress towards global TB targets
Incidence rates falling globally
Incidence falling in all sub-regions
except African
countries with low HIV prevalence
*EME = Established Market Economies
Rat
e pe
r 100
,000
pop
ulat
ion
Central EuropeAfrica-low HIVAfrica-high HIV
Eastern Europe EME* E. Mediterranean
W. PacificSouth-East AsiaLatin America
200300400500600700
100
150
200
250
406080
100120140160
1990 1995 2000 2005
200
250
300
350
400
10152025303540
200
300
400
500
1990 1995 2000 2005
20406080
100120
100150200250300350400
100150200250300350400
1990 1995 2000 2005
Africa-high HIV
Rat
e pe
r 100
,000
pop
ulat
ion
Progress to the prevalence targetCentral EuropeAfrica-low HIV
Eastern Europe EME* E. Mediterranean
W. PacificSouth-East AsiaLatin America
*EME = Established Market Economies
Five regions reached target already
SE Asia and E. Mediterranean may be able to achieve target
African countries far from target, such that target unlikely to be reached globally
Black line marks target level at 50% of 1990 prevalence rate
20
40
60
80
100
15
20
25
30
35
40
5
10
15
20
1990 1995 2000 2005
2025303540455055
1.0
1.5
2.0
2.5
20
30
40
50
60
1990 1995 2000 2005
2
4
6
8
10
12
14
20
40
60
80
100
20
30
40
50
60
70
1990 1995 2000 2005
Progress to mortality targetAfrica-high HIV Africa-low HIV Central Europe
Eastern Europe EME* E. Mediterranean
Latin America South-East Asia W. Pacific
Rat
e pe
r 100
,000
pop
ulat
ion
Four regions appear to have reached target of halving 1990 mortality rate already (green)
SE Asia, E. Mediterranean and E. Europe may be able to achieve target
African countries far from target, such that target unlikely to be reached globally
*EME = Established Market EconomiesBlack line marks target level at 50% of 1990 mortality rate
What about other targets?
Treatment success rateTB/HIV and MDR targetsFunding targets
Treatment success target reached globallySu
cces
sful
trea
tmen
t rat
e (%
) in
DO
TS c
ohor
ts
85
77
79
77
79
81
80
82
82
82
83
84 85
87
40
50
60
70
80
90
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
But not in the Americas, Africa and Europe
Global plan TB/HIV and MDR targets: 2008
Global plan target
• 2.3 million TB patients tested for HIV
• 300,000 started on ART
• 16 million PLHIV screened for TB
• 110,000 X/MDR cases treated
Actual coverage
• 1, 374,000 HIV tested (60% of the planned)
• 109,000 on ART (36% of the planned)
• 1,385,000 screened(8.7% of the planned)
• 30,000 cases notified(27% of the planned)
Funding has increased
technical assistance and R & D not includedData based on ~ 100 countries each year with ~ 94% estimated global cases
0
1
2
3
4
5
2006 2007 2008 2009 2010
US$
bill
ions
Unknown
Global Fund
Grants (excl. GF)
Loans
Government (health system)
Government (NTP budget)
2.7
4.1
But falls short of Global Plan targets, except in E. Europe
All regions except Eastern EuropeData based on ~ 100 countries each year with ~ 94% estimated global cases
In E Europe available funds (AF) exceeds Global plan (GP) targets
0
1
2
3
4
GP AF GP AF GP AF GP AF GP AF
2006 2007 2008 2009 2010
Other
TB/HIV
MDR-TB
DOTSUS$
bill
ions
3.8
1.72.7
1.3
Beyond the global TB targets OF 2015
TB elimination by 2050
(Incidence of active TB < 1 per million)
Treating latent TB is crucial
2 Month rg.4 Month rg.
10 days rg.
Proc Natl Acad Sci U S A. 2009 Aug 18;106(33):13980-5.(Incidence per million)
Conclusion
• Targets are in general on track in several regions but unlikely achievable globally.
• Incidence target has been achieved globally except in Africa with low HIV
• Mortality and prevalence targets are unlikely to be achieved in Africa
• Latent TB treatment with robust and new drug could be crucial for TB elimination