India and China do not have the highest rates of TB, but due to population numbers they contribute 40% of all TB cases globally
2009 (from 2010 report) All forms of TB, 9.4M cases, 1.7M deaths HIV-Associated TB: 1.1M cases, 380K deaths MDR-TB: 440K cases, ~150K deaths
The number of cases is the same estimate as last year, but mortality estimates have dropped from 400,000 in 2009 to 350,000 in 2010.
The geographical distribution of this tragedy is uneven, as sub-Saharan Africa has to suffer 80% of the burden, with several countries reporting over 10,000 deaths for the co-infection per year, and South Africa over 80,000. However, India has a large burden as well.
The estimated annual TB incidence per 100,000 adults increases in a proportional way with the HIV prevalence in adults, 15-49 years of age. When HIV prevalence increases by 1%, the TB incidence increases by 26/100,000 per year.
2010 All forms of TB, 9.4M cases, 1.7M deaths HIV-Associated TB: 1.1M cases, 380K deaths MDR-TB: 440K cases, ~150K deaths
TB/HIV Why do we care about the intersection of the epidemics? Kayt Erdahl, Technical Officer HIV/AIDS & TB Global Programs, PATH CORE Group Fall Meeting October 13, 2011
High Burden Countries (HBC) 22 countries account for 80% of the world’s burden of TB
Data source: WHO Global TB Report 2011 40% of all TB cases
Global Burden of TB and TB/HIV, 2010 *Including deaths among people living with HIV Data from WHO Global TB Report, 2011 Estimated number of cases Estimated number of deaths All forms of TB 8.8 million 1.4 million* All forms of TB, women only 3.2 million 320,000 HIV-Associated TB 1.1 million 350,000 Multidrug-resistant TB (MDR-TB) 650,000 ~150,000 (2008)
Countries in bold are also HBC for TB; Data source: WHO Global TB Report 2011 1 Angola 15 Ethiopia 29 Rwanda 2 Botswana 16 Ghana 30 Sierra Leone 3 Brazil 17 Haiti 31 South Africa 4 Burkina Faso 18 India 32 Sudan 5 Burundi 19 Indonesia 33 Swaziland 6 Cambodia 20 Kenya 34 Thailand 7 Cameroon 21 Lesotho 35 Togo 8 Ctrl African Rep 22 Malawi 36 Uganda 9 Chad 23 Mali 37 Ukraine 10 China 24 Mozambique 38 UR Tanzania 11 Congo 25 Myanmar 39 Viet Nam 12 Cote d’Ivoire 26 Namibia 40 Zambia 13 Djibouti 27 Nigeria 41 Zimbabwe 14 DR Congo 28 Russia
Estimated TB incidence vs. HIV prevalence in high burden countries 0 400 800 1200 1600 0.0 0.1 0.2 0.3 0.4 HIV prevalence, adults 15-49 years Estimated annual TB incidence (per 100K adults , 1999) As HIV prevalence increases by 1%, TB incidence increases by 26/100k/yr Williams B. 3rd Global TB/HIV Working Group Meeting; Montreux, 4-6 June 2003
HIV testing of TB patients is now standard practice in many countries, especially in Africa. In 2010, 34% of notified TB patients knew their status.
Global coverage of ART for TB/HIV patients remains low at 46%, despite a large increase in HIV testing of TB patients
In 2010 2.3 M PLHIV screened for TB (58% of PLHIV) 178,000 PLHIV enrolled on IPT (12% of newly enrolled PLHIV)
Global Plan to Stop TB 2011-2015 Summary of main TB/HIV indicators Data from WHO Global TB Report, 2011 TB/HIV indicators Baseline (2009) 2010 % TB patients tested for HIV 26% 34% % HIV+ TB patients treated with CPT 75% 77% % of HIV+ TB patients treated with ART 37% 46% % of PLHA attending HIV care services who were screened for TB at their last visit ~25% 58% % of PLHA attending HIV care services who were enrolled on IPT; among those eligible <1% 12%
2012 anticipated: $0.6 billion, 50% higher than 2006 at $0.4 billion.
Far short of funding provided to Malaria and HIV/AIDS in 2010:
Malaria $1.8 billion, HIV/AIDS $6.9 billion
Treatment: With the threat of MDR and XDR-TB, there are less drugs available, they are much more expensive, have worse side effects and treatment is 4 times longer – 2 years instead of 6 months.
TB R&D: “The field of research on TB has really missed generations of advances in biology and technology. We really need to bring TB research from the 19th into the 21st century,” -Anthony S. Fauci, director of the NIAID at the release of the WHO Global TB Report 2011.