tuberculosis control dr. yeşim yasİn fall-2013. outline what is tuberculosis (tb)? burden of tb,...
TRANSCRIPT
![Page 1: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/1.jpg)
Tuberculosis Control
Dr. Yeşim YASİN Fall-2013
![Page 2: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/2.jpg)
Outline
• What is Tuberculosis (TB)?
• Burden of TB, TB/HIV, MDR-TB
• Strategy, targets, progress
• Prevention and Control Programmes of TB
• Challenges towards elimination
2
![Page 3: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/3.jpg)
What is TB?
• One of the oldest diseases known in the
history.
• It is a preventable and a curable disease if
detected and treated early.
3
![Page 4: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/4.jpg)
4
![Page 5: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/5.jpg)
Prevelance of infection
• About one-third of the world‘s population is
infected with TB bacilli
people have been infected by TB bacteria
but are not (yet) ill with disease and cannot
transmit the disease.
5
![Page 6: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/6.jpg)
• After a healthy person with a healthy
immune system breaths in TB bacteria, he
or she will have 10% lifetime chance of
developing TB.
• Immune-compromised persons have a
much higher risk of falling ill. 6
![Page 7: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/7.jpg)
active TB (disease)
delays in seeking care/diagnosis/treatment
results in transmission of the
bacteria to others7
![Page 8: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/8.jpg)
People ill with TB (active case)
can infect up to 10-15 people
through close contact over the
course of a year
• Without proper treatment
up to two thirds of people
ill with TB will die. 8
![Page 9: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/9.jpg)
Natural history of TB
Factors
Agent factors
Host factors
Social factors
9
![Page 10: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/10.jpg)
Agent Factors
AgentSource of infection communicability
TB bacilli have a thick waxy coat,they are slow growing and they can survive in the
body for many years in a dormant or inactive state whereby people are infected but
show no signs of TB disease.
The most common source of Tuberculosis infection is
the human case whose sputum is positive for the tubercle bacilli, and who
has either received no treatment for it or not got treated fully. Such sources can discharge the bacilli in
their sputum for years
Transmitted by droplet nuclei
10
![Page 11: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/11.jpg)
Host factors
Host Factors
All age groups
Males>Females Nutrition İmmunity
Host susceptibility is universal, but the risk of infection is directly and mainly related to the degree of exposure.
After 20 years of age, TB tends to affect more males due to higher exposure to infection and higher prevalence of risk factors.
People who are co-infected with HIV and TB are 21 to 34 times more likely to become sick with TB
11
![Page 12: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/12.jpg)
Social factors
Social Factors
Population explosion
Over-crowded
living con.
Under- nutrition
Lack of education
12
![Page 13: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/13.jpg)
Incidence of some selected infectious diseases by years
(per 100000 population), Turkey
Health statistic year book 2010
13
![Page 14: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/14.jpg)
2011 Data-Turkey• Incidence: 24/100K (WHO estimate)• Patients in total: 15.679 (21/100K) registered• Patients in total in Istanbul: 4.898 (36/100K) registered• New cases in Istanbul: 4.457 AFB+ patients: 1.794
(registered)
14
![Page 15: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/15.jpg)
TB mortality risk factors
• Site (higher in positive smear)• Type of disease (association to…)• Timeliness of diagnosis and treatment• Appropriate diagnosis• Mistake in reading X-rays• Mistake in interpreting signs and symptoms
• Timely/Delayed diagnosis• Timely/Delayed treatment• Quality of treatment
![Page 16: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/16.jpg)
Why worry about TB?
16
![Page 17: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/17.jpg)
Some facts• TB is the second (only to HIV/AIDS) greatest killer worldwide due to a
single infectious agent.
• 8.7 million new cases in 2011; 13% is co-infected with HIV
• 22 high-burden countries account for 80% of the world’s TB cases.
• 1.4 million people died: 430.000 were HIV+
• Almost 60.000 people worldwide lives with MDR-TB
• The largest number of new TB cases occurred in Asia, accounting for
60% of new cases globally
• Funding is inadequate
17
![Page 18: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/18.jpg)
Estimated number of cases
• 8.7 million (8.3-9.0 million)• 1.1 million (13%) (1.0-1.2 million)• Up to 0.5 million
Estimated number of deaths
• 1.4 million (1.3-1.6 million)• 430,000 (400,000-460,000)• Unknown, but
probably>150,000
18
All forms of TB
HIV associated TB
MDR-TB
![Page 19: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/19.jpg)
Incidence rates, 2011
19
![Page 20: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/20.jpg)
TB cases, deaths, 1990-2011
20
Incidence Mortality
All cases
HIV+ cases
Peak > 9 million in early 2000s, 8.7 million in 2011
Total mortality peaked early 2000s at >1.8 million 1.4 million in 2011
HIV+ mortality
millions
![Page 21: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/21.jpg)
TB/HIV Coinfection80% of all TB/HIV cases are in Africa TB leading cause of death in PLHIV: ¼ of PLHIV worldwide die due to TB. PLHIV infected with TB: 20-40 times more likely to develop active TB. Untreated, TB in PLHIV leads to death in weeks 21
![Page 22: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/22.jpg)
Distribution of MDR-TB among new TB cases, 1994-2011
22
![Page 23: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/23.jpg)
Number of MDR-TB cases, 2011
23
Russian Federation 44,000 (14% of global MDR burden)
China61,000 (20% of global MDR burden)
India66,000 (21% of global MDR burden) South Africa
8,100 Based on survey data
Pakistan 10,000 (3% of global MDR burden)
Ukraine 9,000 Based on survey data
![Page 24: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/24.jpg)
To date, 84 countries that reported XDR-TB
24
About 9% of MDR-TB cases are XDR
![Page 25: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/25.jpg)
• 1. Pursue high-quality DOTS expansion
• 2. Address TB-HIV, MDR-TB, and needs of the poor and vulnerable
• 3. Contribute to health system strengthening
• 4. Engage all care providers • 5. Empower people with
TB and communities • 6. Enable and promote
research 25
Goal 6: to have halted by 2015 and begun to reverse the incidence…
2015: 50% reduction in TB prevalence and deaths compared to 1990
2050: elimination (<1 case per million population)
![Page 26: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/26.jpg)
Global progress on impact
• 51 million patients cured, 1995-2011
• 20 million lives saved since 1995
• 2015 MDG target on track: global TB incidence rate peaked in early 2000s
• BUT, TB incidence declining too slowly, 1.4 million people still dying, MDR-TB response slow, gaps in financing
26
![Page 27: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/27.jpg)
27
![Page 28: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/28.jpg)
Prevention and Control of TB
![Page 29: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/29.jpg)
29A B
![Page 30: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/30.jpg)
Risk and Prevention-1
1- Cough out TB particles - strength of cough (adults>>>children)
2- Live bacteria- smear + or culture +
3- Cavity30
Risk and Prevention-1
![Page 31: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/31.jpg)
Risk and Prevention-2• Person A• Medication (DOT)• Isolation• <4 years• At night
• Surgical mask
• Person B• Space• Natural ventilation/fan• Air purifying respirator (N95)• Ultra Violet Germicidal Irradiation (UVGI)• High Efficiency Particulate Air (HEPA) Filter• Negative pressure
31
Risk and Prevention-2
![Page 32: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/32.jpg)
TB CONTROL
•Detection and treatment of cases•Treatment of latent infection•Vaccination
32
TB Control
![Page 33: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/33.jpg)
The three priority strategies for TB
prevention and control programs are:
• Identifying and treating individuals who have active TB.
• Finding and screening individuals who have had contact with
TB patients to determine whether they are infected or have
active TB, and providing appropriate treatment.
• Screening populations at high risk for TB infection to detect
infected persons and provide therapy to prevent progression
to active TB.33
![Page 34: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/34.jpg)
Tuberculosis prevention and control
programs
• 1994 “Directly Observed Treatment, Short Course”
(DOTS) strategy
• each country to detect smear-positive TB cases
• offer standardized DOT ,
• with the objective of curing over 85% of TB patients.
34
![Page 35: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/35.jpg)
DOTS
• Governmental commitment to TB Control• Reliable and continious supply of high-
quality Anti-TB drugs•Microbiologic confirmation of TB diagnosis• Supervision (DOT) of standardized short
course Anti-TB theraphy-at least during the initial phase• System for registration and follow-up
35
DOTS
![Page 36: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/36.jpg)
What can DOTS do
• Increase treatment completion and cure rates• Reduce the emergence of drug resistant
TB• Improve cost-effectivenss of TB Control• Reduce TB incidence in conjunction with
other interventions.36
What can DOTS do?
![Page 37: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/37.jpg)
Challenges
• HIV epidemic•MDR-TB, XDR-TB• Health system weakness and political will• Poor infrastructure and lack of support• Private practitioners• Prisons
37
Challenges
![Page 38: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/38.jpg)
DOTS in Turkey
• Since 2003 Ministry of Health performed
pilot studies for DOTs (Directly Observed
Theraphy Short-course).
• In 2006 Tuberculosis Control Programme
was integrated to primary health care
system and DOTs is expanded in Turkey.38
DOTs in Turkey
![Page 39: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/39.jpg)
DOT
• DOT can lead to reductions in
relapse and acquired drug
resistance
39
DOT
![Page 40: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/40.jpg)
Tuberculosis Prevention and Control
Program in Turkey
• Main strategies include:
• BCG vaccination
• Case finding
• Effective chemotheraphy
• Health education
• Chemoprophylaxis
• Monitoring and evaluation system 40
![Page 41: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/41.jpg)
BCG vaccination
BCG only at birth (or first contact with health services)
• This is the current recommendation of the EPI
(Expanded Program on Immunization) and the Global
Tuberculosis Programme and is the policy in our country.
• BCG protects against serious childhood forms of
Tuberculosis, such as TB meningitis and miliary TB.
• It may not protect to a high degree against adult
pulmonary forms of the disease.41
![Page 42: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/42.jpg)
Case finding
• The aim is to reduce the transmission of TB by
screening high risk populations (eg. those at
an increased risk of exposure to TB infection,
most notably contacts of infectious cases) and
to detect and treat active disease earlier than
would otherwise occur. 42
![Page 43: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/43.jpg)
Chemoprophylaxis
• Primary prevention
• Decrease incidence rate of TB
• By using Isoniazid (INH)
43
Chemoprophylaxis
![Page 44: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/44.jpg)
Tuberculosis 1• Tuberculosis control and elimination
2010–50: cure, care, and social development
Knut Lönnroth, Kenneth G Castro, Jeremiah Muhwa Chakaya, Lakhbir Singh Chauhan, Katherine Floyd, Philippe Glaziou, Mario C Raviglione
44
![Page 45: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/45.jpg)
Challenges to “elimination”
1. Commitment by governments and stakeholders fluctuating
2. Funding not secure; catastrophic costs for the poor un-resolved
3. Only 2/3 of estimated cases reported or detected 4. TB/HIV major impact in Africa 5. MDR-TB, with high burden in former USSR , China etc 6. Un-engaged non-state practitioners 7. Social and economic determinants maintaining TB 8. Research in need of intensification and investments
45
![Page 46: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/46.jpg)
1- Lack of commitment
46
![Page 47: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/47.jpg)
2- Funding
47
US
billi
ons
dolla
rs
Funding gap vs Global Plan ~ US$2–3 billion per year Funding gaps reported by countries US$0.7 billion in 2013
2013 2014 2015
![Page 48: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/48.jpg)
3- The case detection/notification gap
• Global notifications Estimated incidence
• 3: The case detection/notification gap Nearly 3 million TB cases either not notified or not detected 481990 2000 2010
TB c
ases
(mill
ions
)3.7
7.88.7
5.8
![Page 49: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/49.jpg)
GeneXpert
4985 countries using it by mid-2013
![Page 50: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/50.jpg)
4- Responding to the TB/HIV epidemic
The WHO policy on collaborative TB/HIV activities
50
![Page 51: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/51.jpg)
4- Responding to TB/HIV epi. through collaborative efforts
51
![Page 52: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/52.jpg)
5- Responding to MDR-TB
The New England Journal of Medicine
MDR Tuberculosis — Critical Steps for Prevention and Control
Eva Nathanson, M.Sc., Paul Nunn, F.R.C.P., Mukund Uplekar, M.D., Katherine Floyd, Ph.D., Ernesto Jaramillo, M.D., Ph.D., Knut Lönnroth, M.D., Ph.D., Diana Weil, M.Sc., and Mario Raviglione, M.D.
52
Review Article
![Page 53: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/53.jpg)
53
WHA resolution 2009 (22 May) includes all essential policies
![Page 54: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/54.jpg)
6- Unregulated private sector• Private sector is first point of care
in many settings. India: 70% of people with cough go first to private practitioners
• Diverse network of formal and informal providers ranging from hospitals and corporate sector to the traditional healers and quacks
• Private sector engagement crucial in closing the gap on case detection
• Contribution to finding people with TB between 10%-40% in countries
• Collaboration exists but still not enough in many settings. Efforts need to be made on both ends
54
![Page 55: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/55.jpg)
7- Alleviation of risk factors & soc-economic determinants
RR for active TB Weighted prevalence (22 HBCs)
Population attributable fraction
HIV infection 20.6/26.7 1.1% 19%
Malnutrition 3.2 16.5% 27%
Diabetes 3.1 3.4% 6%
Alcohol use (>40 g/day)
2.9 7.9% 13%
Active smoking 2.6 18.2% 23%
Indoor air pollution 1.5 71.1% 26%55
![Page 56: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/56.jpg)
8- Intensive investments in R&D to develop new tools
56
Diagnostic Vaccine Treatment
Sputum smear microscopy BCG 1st-line TB drugs Discovered 1882 Developed 1920s Discovered 1943-1970
![Page 57: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/57.jpg)
8- New tool pipelines in 2013
Diagnostics: • 7 new diagnostics or diagnostic methods endorsed by WHO since
2007; • 6 in development; • yet no Point of Care (PoC) test envisaged
Drugs: • 1 new drug (Bedaquiline) approved in late 2012, but probably little
impact on epidemiology; • 1 expected to be approved in 2013; • a regimen and other 2-3 drugs likely to be introduced in the next 4-7
years Vaccines:
• 11 vaccines in advanced phases of development; • 1 just reported with no detectable efficacy
57
![Page 58: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/58.jpg)
8. Research as the key for elimination• 1.For elimination one would need rapid diagnostics at point of
care, potent short treatments, mass treatment of latent TB infection (TLTBI), and potent pre- and post-exposure vaccines. None is available today
• 2.Basic research is fundamental to gain further knowledge and R&D pipelines must be expanded, nurtured and well-financed
• 3.Increased financial resources for research: the need for research is estimated at 2 billion US$ per year; today, about 650 million US$ are invested.
• 4.Develop coalitions to maximize outcomes and ensure a continuum of research efforts so that basic science and R&D pipelines are informed by needs, and operational research allows rapid adaptation and introduction in high-burden settings
58
![Page 59: Tuberculosis Control Dr. Yeşim YASİN Fall-2013. Outline What is Tuberculosis (TB)? Burden of TB, TB/HIV, MDR-TB Strategy, targets, progress Prevention](https://reader033.vdocuments.site/reader033/viewer/2022051412/551aaaf1550346856e8b4b0c/html5/thumbnails/59.jpg)
THANK YOU!
59