PPT Raviglione "Stop TB in my lifetime -Giornata Mondiale della Tubercolosi"
Photo: Riccardo Venturi Giornata Mondiale della Tubercolosi Milano, 14 March 2013 Dr Mario C Raviglione Director Stop TB Department
Overview ü Burden of TB, TB/HIV, MDR-‐TB ü Strategy and targets ü Impact of intervenEons, and progress in control and care
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
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
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
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
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…
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
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
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
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
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.
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