WHO's End TB Strategy 2016-2035
Mukund Uplekar
World TB Day 2015: What do we need to know to reach, treat and cure everyone with TB?
UCL, London - 24 March 2015
The Global Burden of TB
Estimated number
of cases
All forms of TB
9 million
• 3.3 m women
• 0.55 m children
Estimated number
of deaths
1.5 million*
• 510.000 women
• 80.000 children
HIV-associated TB
1.1 million (13%)
360,000
Multidrug-resistant TB
480,000
210,000
Source: WHO Global Tuberculosis Report 2013
* Including deaths attributed to HIV/TB
Global progress on impact - 2013
37 million lives saved since 2000
Reduction in TB mortality rate
45% since 1990
Incidence falling
slowly (1.5%/yr):
2015 MDG on track
4.8 million lives saved
since 2005 through
TB/HIV collaborative
activities
86% cure rate
61 million patients cured,
1995-2013
TB incidence and mortality trends 1990-2013
All TB deaths
Incidence peaked at 9.5 million in 2004
9 million in 2013
Total mortality peaked in 2002 at 1.7 million
1.5 million in 2013
67th World Health Assembly, 19 May 2014
THE END TB STRATEGY 2016-2035
VISION:
A world free of TB
- Zero deaths, disease and suffering due to TB
GOAL:
End the Global TB Epidemic
MILESTONES FOR 2025: 75% reduction in TB deaths (compared with 2015)
50% reduction in TB incidence rate (less than 55 TB cases per 100,000 population)
No affected families facing catastrophic costs due to TB
TARGETS FOR 2035:
95% reduction in TB deaths (compared with 2015)
90% reduction in TB incidence rate (less than 10 TB cases per 100,000 population)
No affected families facing catastrophic costs due to TB
PRINCIPLES:
-
Government stewardship and accountability, with monitoring and evaluation
Strong coalition with civil society organizations and communities
Protection and promotion of human rights, ethics and equity
Adaptation of the strategy and targets at country level, with global collaboration
PILLARS AND COMPONENTS:
1. INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION
A. Early diagnosis of TB including universal drug susceptibility testing; and systematic screening
of contacts and high-risk groups
B. Treatment of all people with TB including drug-resistant TB; and patient support
A. Collaborative TB/HIV activities and management of comorbidities
B. Preventive treatment of persons at high-risk; and vaccination against TB
2. BOLD POLICIES AND SUPPORTIVE SYSTEMS
A. Political commitment with adequate resources for TB care and prevention
B. Engagement of communities, civil society organizations, and public and private care providers
C. Universal Health Coverage policy and regulatory frameworks for case notification, vital registration,
quality and rational use of medicines, and infection control
D. Social protection, poverty alleviation and actions on other determinants of TB
GLOBAL
3. INTENSIFIED RESEARCH AND INNOVATION
A. Discovery, development and rapid uptake of new tools, interventions and strategies
TB B. Research to optimize implementation and impact, and promote innovations
PROGRAMME
Vision, goal, targets, milestones
Vision:
A world free of TB
Zero TB deaths,
Zero TB disease, and
Zero TB suffering
Goal:
End the global TB
epidemic
GLOBAL TB
PROGRAMME
End TB Strategy - Pillars and Principles
Integrated,
patientcentered
TB care
and
prevention
GLOBAL TB
PROGRAMME
Bold
policies and
supportive
systems
Intensified
research
and
innovation
End TB Strategy- Components
1. INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION
A. Early diagnosis of tuberculosis including universal drug-susceptibility testing, and systematic
screening of contacts and high-risk groups
B. Treatment of all people with tuberculosis including drug-resistant tuberculosis, and patient
support
C. Collaborative tuberculosis/HIV activities, and management of co-morbidities
D. Preventive treatment of persons at high risk, and vaccination against tuberculosis
2. BOLD POLICIES AND SUPPORTIVE SYSTEMS
A. Political commitment with adequate resources for tuberculosis care and prevention
B. Engagement of communities, civil society organizations, and public and private care providers
C. Universal health coverage policy, and regulatory frameworks for case notification, vital
registration, quality and rational use of medicines, and infection control
D. Social protection, poverty alleviation and actions on other determinants of tuberculosis
3. INTENSIFIED RESEARCH AND INNOVATION
A. Discovery, development and rapid uptake of new tools, interventions and strategies
B. Research to optimize implementation and impact, and promote innovations
GLOBAL TB
PROGRAMME
End TB Strategy- Components
1. INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION
A. Early diagnosis of tuberculosis including universal drug-susceptibility testing, and systematic
screening of contacts and high-risk groups
B. Treatment of all people with tuberculosis including drug-resistant tuberculosis, and patient
support
C. Collaborative tuberculosis/HIV activities, and management of co-morbidities
D. Preventive treatment of persons at high risk, and vaccination against tuberculosis
2. BOLD POLICIES AND SUPPORTIVE SYSTEMS
A. Political commitment with adequate resources for tuberculosis care and prevention
B. Engagement of communities, civil society organizations, and public and private care providers
C. Universal health coverage policy, and regulatory frameworks for case notification, vital
registration, quality and rational use of medicines, and infection control
D. Social protection, poverty alleviation and actions on other determinants of tuberculosis
3. INTENSIFIED RESEARCH AND INNOVATION
A. Discovery, development and rapid uptake of new tools, interventions and strategies
B. Research to optimize implementation and impact, and promote innovations
GLOBAL TB
PROGRAMME
Application of the End TB Strategy: Projections
Current global trend: -2%/year
Optimize current tools,
pursue universal health
coverage and social
protection
Average
-10%/year
by 2025
Introduce new tools: a vaccine,
a new prophylaxis & treatment Average
regimen, a PoC test
-17%/year
GLOBAL TB
PROGRAMME
-5%/year
Way forward: What WHO will do globally?
Great Benefits
• Norms, strategies and policies
Guidance on
adoption and
adaptation of the
new strategy
GLOBAL TB
PROGRAMME
• Global M&E for impact and progress
• Adaptation for TB elimination in lowincidence countries
• Adoption by WHO Regional Committees
Advocacy and
promotion of the
new strategy
• Access to innovations
• Focus on the most vulnerable populations
• Multisectoral partnerships for social
protection
• Promotion of research and innovation
• Post-2015 SDG agenda
Investment plan
• Investment plan with partners for
resource mobilization
“Global Consultation Towards Elimination of Tuberculosis in
Countries with Low Incidence of Disease”
Rome, 4-5 July 2014
GLOBAL TB
PROGRAMME
Targets for low-incidence countries
<1 TB case per million
<10 TB cases per million
<100 TB cases per million
Pre-elimination: 2035
Current TB burden-2012
in low-incidence countries
in low-incidence countries
GLOBAL TB
PROGRAMME
Elimination: 2050
Action Framework:
8 priority actions for elimination in low-incidence countries
Ensure political
commitment,
funding and
stewardship for
planning and
essential services
of high quality
Address most
vulnerable and
hard-to-reach
groups
Undertake
screening for active
TB and LTBI in TB
contacts and
selected high-risk
groups and provide
appropriate
treatment
Support global
TB prevention,
care and control
Invest in research
and new tools
GLOBAL TB
PROGRAMME
Address special
needs of migrants;
cross-border
issues
Ensure continued
surveillance and
programme
monitoring &
evaluation, and
case-based data
management
Optimize
prevention
and care of drugresistant TB
The Writing Group
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Professor Ibrahim Abubakar, Public Health England, London, UK
Mrs Lia D’Ambrosio, WHO Collaborating Centre for Tuberculosis, Italy
Dr Gerard De Vries, KNCV Tuberculosis Foundation, The Netherlands
Dr Roland Diel, University Hospital Schleswig Holstein, Germany
Dr Paul Douglas, Department of Immigration and Border Protection, Australia
Mr Marc-Andre Gaudreau, Public Health Agency of Canada, Canada
Dr Delia Goletti, National Institute for Infectious Diseases, Rome, Italy
Dr Phil LoBue, Division of TB Elimination, US CDC, USA
Professor GB Migliori, WHO Collaborating Centre for Tuberculosis, Italy
Dr Howard Njoo, Public Health Agency of Canada, Canada
Dr Edilberto Ochoa, IPK – Investigaciones Tuberculosis, Cuba
Dr Ivan Solovic, TB Department, National Institute for TB, Slovakia
Dr Alistair Story, Find and Treat, London, United Kingdom
Dr Tamara Tayeb, National TB Control Programme, Saudi Arabia
Dr Marieke van den Werf, ECDC, Sweden
Dr Jean Pierre Zellweger, Swiss Lung Association, Switzerland
GLOBAL TB
PROGRAMME
WHO secretariat
• Andrei Dadu, EURO
• Haileyesus Getahun, HQ
• Mirtha del Granado, AMRO
• Dennis Falzon, HQ
• Knut Lonnroth, HQ
• Alberto Matteelli, HQ
• Nobuyuki Nishikiori, WPRO
• Mario Raviglione, HQ
• Mukund Uplekar, HQ
• Diana Weil, HQ
Action Framework for England
10 evidence-based areas for action*
1.
improve access to services and ensure
early diagnosis
2.
provide universal access to high quality
diagnostics
3.
improve treatment and care services
4.
ensure comprehensive contact tracing
5.
improve BCG Vaccination uptake
6.
reduce drug-resistant TB
7.
tackle TB in under-served populations
8.
systematically implement new entrant latent
TB (LTBI) screening
9.
strengthen surveillance and monitoring
10. ensure an appropriate workforce to deliver
TB control
GLOBAL TB
PROGRAMME
*Source: Collaborative Tuberculosis Strategy for England 2015 to 2020
Priority indicators for monitoring
implementation of the End TB Strategy
Indicator
Recommended Target
TB treatment coverage
≥ 90%
TB treatment success rate
≥ 90%
% TB-affected households that experience
catastrophic costs due to TB
0%
% Newly notified TB patients diagnosed with WHOrecommended rapid tests
≥ 90%
LTBI treatment coverage
≥ 90%
Contact investigation coverage
≥ 90%
DST coverage of TB patients
≥ 100%
Treatment coverage, new TB drugs
≥ 90%
Documentation of HIV status among TB patients
≥ 90%
Case fatality ratio
≤ 5%
GLOBAL TB
PROGRAMME
*Source: Collaborative Tuberculosis Strategy for England 2015 to 2020
uplekarm@who.int
GLOBAL TB
PROGRAMME