Photo: Riccardo Venturi                          Giornata	  Mondiale	  della	                                  Tubercolosi...
Overview	                 ü  Burden	  of	  TB,	  TB/HIV,	                     MDR-­‐TB	                 ü  Strategy	  an...
The	  Global	  Burden	  of	  TB	  -­‐2011	                                                      Estimated number          ...
Incidence	  rates,	  2011	                                                                                                ...
TB/HIV	  co-­‐infecEon:	  80%	  of	  burden	  in	  Africa	  ü  80%	  of	  all	  TB/HIV	  cases	  are	  in	  Africa	  ü  ...
EsEmated	  number	  of	  MDR-­‐TB	  Cases,	  2011	  >60%	  of	  all	  cases	  are	  in	  5	  countries	                   ...
Who	  carries	  the	  burden	  of	  tuberculosis?	   …mostly,	  the	  most	  vulnerable	  TB	  spreads	  in	  poor,	  crow...
Francesco	  I	  had	  tuberculosis!	      …El Cardenal tiene una salud frágil, consecuencia de una tuberculosis    que lo ...
The	  global	  burden	  of	  TB	  in	  2011:	  	  women	  &	  children	  Estimated TB incidence rates, by country, 2010   ...
The	  global	  response:	  	  Stop	  TB	  Strategy	  &	  Global	  Plan	  1.        Pursue	  high-­‐quality	  DOTS	        ...
Global	  Progress	  on	  impact	                         ü  	  51	  million	  paEents	                             cured,...
EsEmated	  lives	  saved	  2005-­‐2010	  through	  collaboraEve	  TB/HIV	  intervenEons	  	      CumulaFve	  	  2005-­‐10=...
What	  are	  the	  challenges	  in	  2013	  if	  we	  target	  beher	  care,	  control	  and	  ulEmately	  “eliminaEon"?	 ...
Challenge:	  TB	  as	  a	  cause	  of	  maternal	  and	  child	  morbidity	  and	  mortality	  ü  TB	  causes	  1-­‐16%	 ...
AcEon	  for	  MCH	  services	  
CUAMM	  posiEon	  paper	                                                             …First	  mothers	  and	              ...
Many	    thanks	   to	  all	  for	  choosing	  to	  	  Stop	  TB!	  
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PPT Raviglione "Stop TB in my lifetime -Giornata Mondiale della Tubercolosi"

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PPT Raviglione "Stop TB in my lifetime -Giornata Mondiale della Tubercolosi"

  1. 1. Photo: Riccardo Venturi Giornata  Mondiale  della   Tubercolosi   Milano,  14  March  2013   Dr  Mario  C  Raviglione         Director     Stop  TB  Department      
  2. 2. Overview   ü  Burden  of  TB,  TB/HIV,   MDR-­‐TB   ü  Strategy  and  targets     ü  Impact  of  intervenEons,   and  progress  in  control   and  care    
  3. 3. The  Global  Burden  of  TB  -­‐2011   Estimated number Estimated number of cases of deaths All  forms  of  TB   8.7  million          1.4  million*   (8.3–9.0  million)   (1.3–1.6  million)   HIV-­‐associated  TB      1.1  million  (13%)   430,000    (1.0–1.2  million)   (400,000–460,000)   MulFdrug-­‐resistant  TB   630,000     Unknown,  but   (460,000-­‐790,000)   out  of  ~12  million     probably  >  150,000     prevalent  TB  cases  Source:  WHO  Global  Tuberculosis  Report  2012   *  Including  deaths  aUributed  to  HIV/TB  
  4. 4. Incidence  rates,  2011   0–24 25–49 50–149 150–299 ≥300 Per  100  000  populaEon     Highest  rates  in  Africa,  linked  to  high  rates  of  HIV  infecEon   ~80%  of  HIV+  TB  cases  in  Africa  
  5. 5. TB/HIV  co-­‐infecEon:  80%  of  burden  in  Africa  ü  80%  of  all  TB/HIV  cases  are  in  Africa  ü  TB  leading  cause  of  death  in  PLHIV    ü  ¼    of  PLHIV    worldwide  die  due  to  TB.    ü  PLHIV  infected  with  TB  20-­‐40  Emes   more  likely  to  develop  acEve  TB.  ü  Untreated,  TB  in  PLHIV  leads  to  death   in  weeks  
  6. 6. EsEmated  number  of  MDR-­‐TB  Cases,  2011  >60%  of  all  cases  are  in  5  countries   Russian  FederaEon   44,000     (14%  of  global  MDR  burden)     China   61,000   (20%  of  global  MDR   South  Africa   burden)     8,100   Based  on  old     survey  data   Pakistan   10,000   India   Philippines   (3%  of  global  MDR   burden)     66,000   11,000   (21%  of  global  MDR   (4%  of  global   burden)     MDR  burden)    The  boundaries  and  names  shown  and  the  designaFons  used  on  this  map  do  not  imply  the  expression  of  any  opinion  whatsoever  on  the  part  of  the  World  Health  OrganizaFon  concerning  the  legal  status  of  any  country,  territory,  city  or  area  or  of  its  authoriFes,  or  concerning  the  delimitaFon  of  its  fronFers  or  boundaries.    DoUed  lines  on  maps  represent  approximate  border   lines  for  which  there  may  not  yet  be  full  agreement.     ©  WHO  2012.  All  rights  reserved  
  7. 7. Who  carries  the  burden  of  tuberculosis?   …mostly,  the  most  vulnerable  TB  spreads  in  poor,  crowded  &  poorly  venElated  seangs   500,000  women  and   65,000  children  die  of   Migrants,  prisoners,  minoriEes,   TB  each  year;  10  million   refugees  face  risks,  discriminaEon   “TB”  orphans   &  barriers  to  care  TB  linked  to  HIV  infecEon,  malnutriEon,  alcohol,  drug  and  tobacco  use,  diabetes    
  8. 8. Francesco  I  had  tuberculosis!   …El Cardenal tiene una salud frágil, consecuencia de una tuberculosis que lo atacó cuando era un niño y le dejó secuelas: le falta la parte superior alveolar del pulmón derecho… Sin embargo, físicamente es fuerte. El mismo se esfuerza para no ser menos que los demás y practica natación…
  9. 9. The  global  burden  of  TB  in  2011:    women  &  children  Estimated TB incidence rates, by country, 2010 TB cases per 100 000 Estimated Estimated 0–24 25–49 50–99 100–299 >=300 number of number of No estimate cases deaths All forms of TB 2.9 million 500,000 * (in women) (range, 2.6–3.2 million) (range, 400,000–600,000) All forms of TB 500,000 64,000* (Children <15 yr) (470,000–510,000) (range, 58,000–71,000) * excluding deaths among HIV+ people
  10. 10. The  global  response:    Stop  TB  Strategy  &  Global  Plan  1.  Pursue  high-­‐quality  DOTS   To  save  lives,  prevent  suffering,  protect  the   expansion   vulnerable,  &  promote  human  rights  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  communiEes  6.    Enable  and  promote   research  
  11. 11. Global  Progress  on  impact   ü   51  million  paEents   cured,  1995-­‐2011   ü   20  million  lives  saved   since  1995   ü     2015  MDG  target  on   track:  global  TB   incidence  rate  peaked   in  early  2000s     ü   BUT,  TB  incidence   declining  too  slowly,     1.4  million  people  sFll   dying,  MDR-­‐TB   response  slow,  gaps  in   financing    
  12. 12. EsEmated  lives  saved  2005-­‐2010  through  collaboraEve  TB/HIV  intervenEons     CumulaFve    2005-­‐10=  910,000  (800,000  –  1,100,000)      
  13. 13. What  are  the  challenges  in  2013  if  we  target  beher  care,  control  and  ulEmately  “eliminaEon"?   1.  Funding  not  secure  at  system  and  individual  level:  TB  is  a  catastrophic   expenditure  for  the  poor     2.  TB/HIV  major  impact  in  Africa,  especially  in  women  and  children     3.  Weak  health  policies,  systems  and  services     4.  Links  with  maternal  and  children  services  not  yet  a  rouEne   5.  Un-­‐engaged  non-­‐state  pracEEoners,  NGOs,  FBOs  and  communiEes   6.  MDR-­‐TB  care  and  cure  inadequate,  especially  among  PLHIV   7.  Social  and  economic  determinants  maintaining  TB   8.  Research  awakening  needed  for  new  diagnosEcs,  drugs  and  vaccines  
  14. 14. Challenge:  TB  as  a  cause  of  maternal  and  child  morbidity  and  mortality  ü  TB  causes  1-­‐16%  of  all  inferElity  and  15-­‐40%  of  tubal  inferElity  ü  Facility  based  studies:  12-­‐14%  of  all  TB    cases  are  in  children  ü  TB  prevenEon  for  child  contacts  not  pracEced    ü  Studies  from  SS  Africa  and  India  showed:       –  TB  as  a  cause  of  all  maternal  mortality:  6-­‐15%     –  TB  as  a  cause  of  indirect  maternal  mortality:  15-­‐34%  References:    Khan  M  et  al,  AIDS  2001;  15:1857–63.  Ahmed  Y  et  al,  Int  J  Tuberc  Lung  Dis  1999;  3:675–80.  Panchabhai  TS  et  al,.  J  Postgrad  Med  2009;  55:8–11.  Menendez  C  et  al.  PLoS  Med  2008;  5:e44.  
  15. 15. AcEon  for  MCH  services  
  16. 16. CUAMM  posiEon  paper   …First  mothers  and   children  (with  TB)….     CUAMM  deciding  to   get  engaged  at  all   levels  in  the  fight   against  TB,  as  there   cannot  be  proper   maternal  and  child  care   in  Africa  without   addressing  asserFvely  Prepared  in  collabora:on  with  the  top   TB  and  TB/HIV  Italian  experts  in  TB    
  17. 17. Many   thanks   to  all  for  choosing  to    Stop  TB!  

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