This document summarizes tuberculosis monitoring indicators for the WHO European Region in 2016. It analyzes 19 indicators across three areas of intervention: integrated patient-centered care and prevention, bold policies and supportive systems, and intensified research and innovation. For most indicators, only a small number of countries met the targets, suggesting more progress is still needed to tackle TB across the European Region.

1. Monitoring the implementation of
the TB Action Plan for the WHO
European Region, 2016–2020
EU/EEA situation in 2016
ECDC Tuberculosis Programme
European Centre for Disease Prevention and Control
Stockholm, 24 March 2018
1

2. Three areas of intervention with 26
indicators to assess countries’
performance in tackling TB*
2
1. Integrated patient-centred care and prevention
2. Bold policies and supportive system
3. Intensified research and innovation
* 19 indicators out of 26 are analysed for 2016

3. 1. Integrated patient-centred
care and prevention
3

4. 1.A. Systematic screening of contacts and
high-risk groups
Indicator 1.A.1 Percentage of coverage for population at risk with systematic screening for active TB
and latent tuberculosis infection (LTBI) (only TB contacts evaluated), 2016
4
Target >80%
0% 20% 40% 60% 80% 100%
Total EU/EEA
Portugal
Norway
Bulgaria
Lithuania
Slovakia
Target: 80%
Status 2016: Five countries reported data, four countries met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data

5. 1.B. Early diagnosis of all forms of TB and
universal access to drug susceptibility testing,
including the use of rapid tests
Indicator 1.B.1 Percentage of newly notified TB patients diagnosed using WHO-recommended rapid tests
5
Target: 40%
Status 2016: 25 countries reported data, nine met the target
Target = 40%
0%
20%
40%
60%
80%
100%
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data

6. 1.B. Early diagnosis of all forms of TB and
universal access to drug susceptibility testing,
including the use of rapid tests
Indicator 1.B.2 First-line drug susceptibility testing (DST) coverage (%) among all
bacteriologically confirmed TB cases (G1)
6
Target: 100%
Status 2016: 30 countries reported data, seven met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
0%
20%
40%
60%
80%
100%
Target = 100%

7. 1.B. Early diagnosis of all forms of TB and
universal access to drug susceptibility testing,
including the use of rapid tests
Indicator 1.B.3: Percentage of rifampicin-resistant and multidrug-resistant (RR/MDR) TB case detection rate (%)
7
Target: 85%
Status 2016: 24 countries reported data, nine met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
0%
20%
40%
60%
80%
100%
Target = 85%

8. 1.B. Early diagnosis of all forms of TB and
universal access to drug susceptibility testing,
including the use of rapid tests
Indicator 1.B.4 TB notification rate per 100 000 population (E1)
8
Target: below 24.6
Status 2016: 30 countries reported data, 27 met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
Target = 24.6
0
10
20
30
40
50
60
70
Notificationrateper100000population

9. 1.B. Early diagnosis of all forms of TB and
universal access to drug susceptibility testing,
including the use of rapid tests
Indicator 1.B.5: percentage of TB case detection rate (%)
9
Target: 84%
Status 2016: 30 countries reported data, 26 met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
Target = 84%
0%
20%
40%
60%
80%
100%

10. 1.B. Early diagnosis of all forms of TB and
universal access to drug susceptibility testing,
including the use of rapid tests
Indicator 1.B.6 Percentage of RR/MDR TB among new TB patients (E2)
10
Target: Decreasing percentage compared to baseline in 2014
Status 2016: 30 countries reported data, 14 met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
0%
5%
10%
15%
20%
2016 situation Baseline 2014

11. 1.B. Early diagnosis of all forms of TB and
universal access to drug susceptibility testing,
including the use of rapid tests
Indicator 1.B.7 Percentage of RR/MDR TB among previously treated TB patients
11
Target: Decreasing percentage compared to baseline in 2014
Status 2016: 24 countries participated, 14 met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
0%
20%
40%
60%
80%
2016 situation Baseline 2014

12. 1.C. Equitable access to quality treatment and continuum
of care for all people with tuberculosis, including drug-
resistant tuberculosis; and patient support to facilitate
treatment adherence
Indicator 1.C.1 Percentage of hospitalisation among new TB patients (E3)
12
Target: Decreasing percentage compared to baseline in 2014 (data for 2014 not available)
Status 2016: 18 countries reported data
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Total EU/EEA
Cyprus
Iceland
Portugal
Netherlands
Luxembourg
Sweden
Norway
Ireland
Estonia
Finland
Romania
France
Bulgaria
Slovakia
Lithuania
Slovenia
Czech Republic
Latvia

13. 1.C. Equitable access to quality treatment and continuum
of care for all people with tuberculosis, including drug-
resistant tuberculosis; and patient support to facilitate
treatment adherence
Indicator 1.C.2 Percentage of detected RR/MDR TB enrolled in treatment
13
Target: 100%
Status 2016: 26 Member States reported data, 22 met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
Target = 100%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%

14. 1.C. Equitable access to quality treatment and continuum
of care for all people with tuberculosis, including drug-
resistant tuberculosis; and patient support to facilitate
treatment adherence
Indicator 1.C.3 Treatment success rate (G2)
14
Target: 85% for new and relapse cases
Status 2016: 24 Member States reported data, six met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
Target = 85%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%

15. 1.C. Equitable access to quality treatment and continuum
of care for all people with tuberculosis, including drug-
resistant tuberculosis; and patient support to facilitate
treatment adherence
Indicator 1.C.3: Treatment success rate
15
Target: 85% for new and relapse cases
Status 2016: 24 Member States reported data, six met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
Not reporting
≥ 85%
60 to 84.9%
Proportion of treatment
success
< 60%

16. 1.C. Equitable access to quality treatment and continuum
of care for all people with tuberculosis, including drug-
resistant tuberculosis; and patient support to facilitate
treatment adherence
Indicator 1.C.4 TB treatment success rate among the RR/MDR TB cohort, 2016
16
Target: 75% for new and relapse RR/MDR TB cases
Status 2016: 20 Member States reported data, four met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Total EU/EEA
Croatia
Lithuania
Poland
Germany
Romania
Czech Republic
Bulgaria
Denmark
Ireland
Slovakia
Portugal
Belgium
United Kingdom
Austria
Estonia
Latvia
Norway
Netherlands
Sweden
Hungary
Target = 75%

17. 1.C. Equitable access to quality treatment and continuum
of care for all people with tuberculosis, including drug-
resistant tuberculosis; and patient support to facilitate
treatment adherence
Indicator 1.C.4: TB treatment success rate among the RR/MDR TB cohort, 2016
17
Target: 75% for new and relapse RR/MDR TB cases
Status 2016: 20 Member States reported data, four met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
Not reporting
≥ 75%
40 to 74.9%
Proportion of treatment
success
< 40%

18. 1.C. Equitable access to quality treatment and continuum
of care for all people with tuberculosis, including drug-
resistant tuberculosis; and patient support to facilitate
treatment adherence
Indicator 1.C.5 TB mortality rate (ICD A15-19)*
18
Target: below 2.7 deaths for WHO European Region
Status 2016: calculated for 30 EU/EEA countries, 28 met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
Target = 2.7
0
2
4
6
8
Rateper100000population
*WHO estimates for 2016

19. 1.D. Collaborative TB/HIV activities,
and management of relevant co-morbidities
Indicator 1.D.1 Percentage of detected cases among estimated incident TB/HIV co-infected cases
19
Target: 100%
Status 2016: 16 Member States reported data, one met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
Target = 100%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Subtotal EU/EEA
Hungary
Ireland
Belgium
Luxembourg
Malta
Czech Republic
Portugal
Norway
Latvia
Spain
Netherlands
Lithuania
Romania
Denmark
Estonia
Slovenia

20. 1.D. Collaborative TB/HIV activities,
and management of relevant co-morbidities
Indicator 1.D.2 HIV testing coverage
20
Target: 100%
Status 2016: 20 Member States reported data, one met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
0% 20% 40% 60% 80% 100%
Subtotal EU/EEA
Hungary
Luxembourg
Denmark
Czech Republic
Ireland
Slovakia
Belgium
Spain
Netherlands
Portugal
Lithuania
Romania
Latvia
Bulgaria
Slovenia
Cyprus
Norway
Malta
Estonia
Iceland
Target=100%

21. 1.D. Collaborative TB/HIV activities,
and management of relevant co-morbidities
Indicator 1.D.3 Percentage of HIV co-infection among all TB (new and relapse TB cases)
21
Target: Decrease compared to baseline in 2014
Status 2016: 20 Member States reported data, 10 met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
0% 20% 40% 60% 80%
Total EU/EEA
Bulgaria
Cyprus
Iceland
Slovakia
Slovenia
Czech Republic
Romania
Ireland
Lithuania
Netherlands
Norway
Hungary
Denmark
Belgium
Spain
Latvia
Estonia
Portugal
Malta
Luxembourg
Baseline 2014 2016 situation

22. 1.D. Collaborative TB/HIV activities,
and management of relevant co-morbidities
Indicator 1.D.4 Percentage of HIV/TB co-infected patients enrolled in antiretroviral therapy (ART)
22
Target: 100%
Status 2016: 8 Member States reported data, four met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
Target = 100%
0% 20% 40% 60% 80% 100%
Subtotal EU/EEA
Latvia
Netherlands
Ireland
Estonia
Malta
Norway
Romania
Slovenia

23. 1.D. Collaborative TB/HIV activities,
and management of relevant co-morbidities
Indicator 1.D.5 LTBI treatment enrolment rate (%) among people living with HIV/AIDS (PLHIV)
23
Target: 30%
Status 2016: Data were not available for 2016
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data

24. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Total EU/EEA
Spain
Norway
Lithuania
Slovakia
1.E. Management of latent tuberculosis infection
and preventive treatment of persons at high risk,
and vaccination against tuberculosis
Indicator 1.E.1: Percentage contact investigation coverage
24
Target: 90%
Status 2016: 4 Member States reported data, four met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
Target = 90%

25. 1.E. Management of latent tuberculosis infection
and preventive treatment of persons at high risk,
and vaccination against tuberculosis
Indicator 1.E.2: Percentage of LTBI treatment coverage among childhood TB contacts aged under five years
25
Target: 90%
Status 2016: Three Member States reported data, one met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Total EU/EEA
Norway
Slovenia
Slovakia
Target = 90%

26. 2. Bold policies and
supportive systems
26

27. 2.A. Political commitment with adequate resources,
including universal health coverage policy
Indicator 2.A.1 Number of Member States that have a regular TB control/elimination performance
publication every five years (E8)
27
Target: TB control/elimination performance publication published
Status 2016: Data were not available for 2016
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
2.B. Health systems strengthening in all functions, including well-
aligned financing mechanisms for tuberculosis and human resources
Indicator 2.B.1 Percentage of TB patients and their households that experience catastrophic financial
consequences due to TB (G8) (E9)
Target: Close to 0
Status 2016: Data were not available for 2016

28. 2.C. Regulatory frameworks for case-based
surveillance, strengthening vital registration, quality
and rational use of medicines, and pharmacovigilance
Indicator 2.C.1 Treatment coverage with new TB drugs (%)
28
Target: 20%
Status 2016: Data were not available for 2016
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
2.D. Community systems and civil society engagement
Indicator 2.D.1 Number of Member States with functioning multi-stakeholder coalitions advocating for TB
care and resources
Target: Not defined
Status 2016: Data were not available for 2016

29. 2.E. Social protection, poverty alleviation and
actions on other determinants of tuberculosis,
such as migration and prisons
Indicator 2.E.1: Percentage treatment success of new and relapse TB cases among prisoners
29
Target: 85%
Status 2016: 13 countries reported data, four met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
Target = 85.0
0 10 20 30 40 50 60 70 80 90 100
Total EU/EEA
Poland
Hungary
Netherlands
Portugal
Belgium
Lithuania
United Kingdom
Latvia
Czech Republic
Bulgaria
Estonia
Romania
Slovakia
Percentage of treatment success

30. 2.E. Social protection, poverty alleviation and
actions on other determinants of tuberculosis,
such as migration and prisons
Indicator 2.E.1 Treatment success of new and relapse TB cases among prisoners
30
Target: 85%
Status 2016: 13 countries reported data, four met the target
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data
Not reporting
≥ 85%
60 to 84.9%
Proportion of treatment
success
< 60%

31. 3. Intensified research and
innovation
31

32. 3.A. Discovery, development and rapid uptake of
new tools, interventions and strategies
Indicator 3.A.1 European Tuberculosis Research Initiative established by mid-2016
32
Target: Established
Status 2016: Country-specific indicators are not defined for 2016
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018– 2016 data

33. Summary by activity related to areas of
intervention, EU/EEA, 2016
1. Integrated, patient-centred care and prevention
• Five activities with 20 indicators defined, nine targets met at EU/EEA
level, seven targets not met, and one target not defined.
2. Bold policies and supportive system
• Five activities with five indicators defined, for four targets data were not
available for EU/EEA countries, one target not met.
3. Intensified research and innovation
• One activity with one indicator defined and country level target not
defined.
33