Targets for low-incidence countries

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The End TB Strategy
Role of WHO in supporting implementation
of the new global strategy
Philippe Glaziou, on behalf of
Mario RAVIGLIONE, Director
Technical Advisory Group meeting, WHO/WPRO
Manila 9-12 December 2014
Global Burden of TB in 2013
Estimated number
of cases
All forms of TB
9 million
126 per 100,000
• 550,000 in children
• 3.3 m in women
Estimated number
of deaths
1.5 million
• 80,000 in children
• 510,000 in women
HIV-associated TB
1.1 million (13%)
360,000
Multidrug-resistant TB
480,000
210,000
TB cases and deaths, 1990–2013
9 million incident cases in 2013
5.7 million reported to WHO
1.5 million deaths in 2013
All cases
HIV-negative
HIV-positive cases
1.1m
HIV-positive
480,000 MDR-TB, 9% with XDR
Highest % in the former
USSR countries
India, China, Russia, Pakistan and Ukraine
have 60% of all MDR-TB cases
136,000 detected
(2013)
Accelerated
MDR detection,
but widening
treatment gap
97,000 treated (2013)
48% MDR
treatment
success globally
MDR-TB: Five priority actions
Response to TB/HIV means cutting
transmission and mortality
78% of TB/HIV
cases in Africa
Other co-morbidities emerging in other regions
48% global HIV testing
coverage, 76% in Africa
Intensifying research
The needs are clear:
• Understand pathogenesis &
immunity
• PoC diagnostic tests
• Short regimens incl. for LTBI
• Post-exposure vaccine
• Epidemiological, health system,
implementation research
Funding gap
• US$ 8 billion per year required for the
response
– US$ 2 billion gap
• US$ 2 billion required for R&D
• Cost per case US$ 100-500
• Cost per MDR case US$ 9,000-49,000
Global progress on impact - 2014
TARGETS ON TRACK
Reduction in TB mortality rate of
45% since 1990
37 million lives saved since 2000
86% cure rate and 61 million
patients cured, 1995-2013
BUT….
incidence falling too slowly at
1.5%/year
Challenges: 5 priorities for action
5 PRIORITIES TO ELIMINATE TB
1.
Reaching the “missed” cases
(3 million not in the system)
2.
Address MDR-TB as crisis
3.
Accelerate response to TB/HIV
4.
Increase financing to close
resource gaps
5.
Intensify research and ensure
rapid uptake of innovations
67th World Health Assembly, Geneva, May 2014
Global projections to 2035
The End TB Strategy: Vision, goal, targets
Vision: A world free of TB
Zero TB deaths, Zero TB disease, and Zero TB suffering
Goal: End the Global TB epidemic (<10 cases per 100,000)
Target 1
95% reduction in
deaths due to TB
(compared with
2015)
Target 2
90% reduction in TB
incidence rate
(compared with
2015)
Target 3
No affected
families face
catastrophic
costs due to TB
3 pillars and 4 Principles
Integrated,
patientcentered
TB care
and
prevention
Bold
policies and
supportive
systems
Intensified
research
and
innovation
The End TB Strategy components
1. INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION
A.
B.
C.
D.
Early diagnosis, universal DST, screening of contacts and high-risk groups
Treatment of all, including DR-TB, patient support
Collaborative TB/HIV activities, management of co-morbidities
Preventive treatment of persons at high risk, vaccination against tuberculosis
2. BOLD POLICIES AND SUPPORTIVE SYSTEMS
A. Political commitment, adequate resources for tuberculosis care and prevention
B. Engagement of communities, civil society, and public and private care providers
C. Universal health coverage policy, regulatory frameworks for notification, vital
registration, rational use of medicines, infection control
D. Social protection, poverty alleviation and actions on other determinants of TB
3. INTENSIFIED RESEARCH AND INNOVATION
A. Discovery, development, rapid uptake of new tools
B. Research to optimize implementation, impact - promote innovations
“Global Consultation Towards Elimination of Tuberculosis in
Countries with Low Incidence of Disease”
Rome, 4-5 July 2014
Countries with < 10/100,000 TB cases/year, notified all forms cases & > 300k population
Other countries progressing rapidly or with potential to consider elimination in the future
Targets for low-incidence countries
<1 case per million
<10 cases per million
<100 cases per million
Pre-elimination: 2035
Current TB burden-2012
in low-incidence countries
in low-incidence countries
Elimination: 2050
Way forward: What will WHO do globally?
Guidance on adoption
and adaptation of the
new strategy
• Norms, strategies and policies
• Global M&E for impact and progress
• Adaptation towards elimination in lowincidence countries
• Support ROs' efforts in adopting &
adapting
Advocacy and
promotion of the new
strategy
• Access to innovations
• Focus on the most vulnerable populations
• Multi-sectoral partnerships for social
protection
• Promotion of research and innovation
Investment plan
• Investment plan with partners for resource
mobilization
What will WHO do in countries?
1. Technical assistance to adapt, plan, and
implement the new strategy with focus on:
•
•
•
•
•
Vulnerable communities
Missed cases, TB/HIV and MDR-TB
Monitoring & evaluation
Research, application of innovations
Social development
2. Support in resource mobilization
• Partnership with GF on TA for epidemiological assessment,
programme reviews, NSP, and concept note development
• Partnership with UNITAID to strengthen diagnostic capacity
and access to new/essential commodities
• Close collaboration with other international donors
Conclusions
1. Global achievements also depend on success in the regions,
especially WPR, with nearly 20% of the global burden
2. Reaching the 2025 and 2035 targets in WPR requires…
• In middle- and high-incidence countries: full adoption,
financing and implementation of the new End TB Strategy;
• In low-incidence countries, TB Elimination Action Framework,
intensified support to higher-incidence countries
3. WHO’s Global TB Programme committed to support all efforts
by countries in WPR and by WHO/WPRO to make TB
elimination a reality
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