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WHO REPORT 2008

Tuberculosis (TB) is a major cause of illness and death worldwide, especially in Asia and Africa. Globally, 9.2 million new cases and 1.7 million deaths from TB occurred in 2006, of which 0.7 million cases and 0.2 million deaths were in HIV-positive people. Population growth has boosted these numbers compared with those reported by the World Health Organization (WHO) for previous years. More positively, and reinforcing a finding first reported in 2007, the number of new cases per capita appears to have been falling globally since 2003, and in all six WHO regions except the European Region where rates are approximately stable. If this trend is sustained, Millennium Development Goal 6, to have halted and begun to reverse the incidence of TB, will be achieved well before the target date of 2015. Four regions are also on track to halve prevalence and death rates by 2015 compared with 1990 levels, in line with targets set by the Stop TB Partnership. Africa and Europe are not on track to reach these targets, following large increases in the incidence of TB during the 1990s. At current rates of progress these regions will prevent the targets being achieved globally.

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Research
 

Tuberculosis | Researchers Plan To Study Effects of HIV, TB on Children's Brains
[Mar 14, 2008]

 
Researchers at Stellenbosch University's medical school in South Africa plan to conduct a study to examine the effects of tuberculosis and HIV on areas of children's brains, which could lead to better ways to diagnose TB in the population, the Independent Online reports. The researchers are waiting to hear whether they will receive a grant from NIH to conduct the research.

Stellenbosch radiology professor Savvas Andronikou and colleagues plan to use a new magnetic resonance imaging scanner to examine the brains of 100 children annually who have been diagnosed with HIV, TB or HIV/TB coinfection. The researchers will work to identify markers that can be used to diagnose TB in children using less sophisticated scans, such as chest X-rays. Andronikou said that when researchers compare CT scans with MRI scans, they "find that diagnostic features are being missed in as many as 30% of cases. And chest X-rays are even more unreliable." He added that sputum tests, which are the current standard for TB diagnosis, are about 33% effective.

Andronikou said the "step-down research" will prove "something using high-end imaging to secure the most reliable imaging on cheaper and more widely available equipment." He added that the medical school is a "suitable environment" for the study. "We have so many patients with TB and HIV, high-tech facilities and the most experienced researchers and clinicians in the field," he said, adding that neuroimaging could help find better ways to manage TB and HIV. "We're looking for a new take on making cheaper and accessible things like X-rays more reliable so that we have an alternative to the currently long waits for results from laboratories," Andronikou said (Caelers, Independent Online, 3/13).
 
 
WHO REPORT 2007
 
Global Tuberculosis Control - Surveillance, Planning, Financing

Global Tuberculosis Control 2007, the eleventh annual report in the series, marks a watershed in the epidemiology and control of tuberculosis (TB). With the latest surveillance data (for 2005), we can ask whether national TB control programmes (NTPs) around the world met the 2005 targets of 70% case detection and 85% cure set by the World Health Assembly. Looking forward from 2006, we can consider how effectively the Stop TB Strategy was launched in its first year, through implementation of The Global Plan to Stop TB, 2006–2015. And, as international debate about TB control focuses more on epidemiological impact (as the consequence of implementation), we can assess whether countries with a high burden of TB, regions of the World Health Organization (WHO) and the world as a whole are on track to meet the United Nations Millennium Development Goals (MDGs) for TB by 2015.

Read complete article on the link provided
http://www.who.int/tb/publications/global_report/2007/pdf/full.pdf
 
Tuberculosis – By 2015, to have halted and begun to reverse the incidence of malaria and other major diseases.
 

Are we on track to meet the target?
There has been substantial progress in reversing the spread of TB in Asia and Latin America and the Caribbean. This is offset however by an increase of the problem in sub-Saharan Africa and the Commonwealth of Independent States, where the number of TB cases (excluding people who are HIV positive) has increased between 1990 and 2005.

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International Tuberculosis Incidence Rates

 

The following rates are based upon the World Health Organization's (WHO) most recently available three years (2003, 2004 and 2005) of estimated sputum smear positive pulmonary tuberculosis (TB) rates. The three year moving average is used to adjust for unstable rates in some jurisdictions. The estimated sputum smear positive pulmonary TB rates are used, rather than the country/territory reported incidence rates, as they adjust for under-reporting of cases in some jurisdictions and are more indicative of the current risk of being infected by residence or prolonged travel in the country/territory. These rates are effective March 24, 2007 and will be revised annually.

For advice on the use of these rates in TB screening programs, please contact your local public health unit/TB program, provincial/territorial TB program or Tuberculosis Prevention and Control, Public Health Agency of Canada.

Sources for current calculations: World Health Organization, Global Tuberculosis Control: Surveillance, Planning, Financing. Who Reports 2005, 2006 and 2007. Geneva, Switzerland,
Countries WHO estimated sputum smear positive pulmonary TB rate per 100 000 (3 year average) Countries WHO estimated sputum smear positive pulmonary TB rate per 100 000 (3 year average)
Afghanistan 125 Libyan Arab Jamahiriya 9
Albania 10 Lithuania 29
Algeria 24 Luxembourg 5
American Samoa 10 Madagascar 99
Andorra 8 Malawi 175
Angola 115 Malaysia 46
Anguilla 11 Maldives 21
Antigua & Barbuda 3 Mali 125
Argentina 19 Malta 3
Armenia 33 Marshall Islands 52
Australia 3 Mauritania 130
Austria 6 Mauritius 29
Azerbaijan 34 Mexico 13
Bahamas 17 Micronesia 34
Bahrain 19 Monaco 1
Bangladesh 105 Mongolia 86
Barbados 5 Montenegro 15
Belarus 26 Montserrat 4
Belgium 6 Morocco 47
Belize 22 Mozambique 189
Benin 39 Myanmar 76
Bermuda 2 Namibia 290
Bhutan 48 Nauru 25
Bolivia 98 Nepal 86
Bosnia & Herzegovina 24 Netherlands 3
Botswana 259 Netherlands Antilles 4
Brazil 27 New Caledonia 21
British Virgin Islands 7 New Zealand 5
Brunei Darussalam 24 Nicaragua 27
Bulgaria 18 Niger 71
Burkina Faso 84 Nigeria 125
Burundi 147 Niue 15
Cambodia 226 Northern Mariana Is 29
Cameroon 76 Norway 2
Canada 2 Oman 5
Cape Verde 77 Pakistan 82
Cayman Islands 2 Palau 26
Central African Republic 134 Panama 20
Chad 113 Papua New Guinea 107
Chile 7 Paraguay 31
China 46 Peru 80
China, Hong Kong SAR 34 Philippines 132
China, Macao SAR 37 Poland 13
Colombia 22 Portugal 18
Comoros 21 Puerto Rico 2
Congo 162 Qatar 26
Cook Islands 11 Rep. Korea 41
Costa Rica 6 Republic of Moldova 62
Côte d'Ivoire 168 Romania 64
Croatia 19 Russian Federation 51
Cuba 4 Rwanda 160
Cyprus 2 Saint Kitts & Nevis 5
Czech Republic 5 Saint Lucia 7
Denmark 3 Samoa 12
Djibouti 328 San Marino 3
Dominica 7 Sao Tome & Principe 48
Dominican Republic 41 Saudi Arabia 18
DPR Korea 80 Senegal 111
DR Congo 158 Serbia 15
Ecuador 60 Seychelles 15
Egypt 12 Sierra Leone 199
El Salvador 24 Singapore 16
Equatorial Guinea 95 Slovakia 9
Eritrea 121 Slovenia 7
Estonia 20 Solomon Islands 39
Ethiopia 154 Somalia 156
Fiji 12 South Africa 252
Finland 4 Spain 12
France 5 Sri Lanka 27
French Polynesia 13 St Vincent & Grenadines 13
Gabon 117 Sudan 98
Gambia 105 Suriname 29
Georgia 37 Swaziland 469
Germany 4 Sweden 2
Ghana 91 Switzerland 3
Greece 8 Syrian Arab Republic 18
Grenada 2 Tajikistan 82
Guam 23 TFYR Macedonia 14
Guatemala 34 Thailand 63
Guinea 105 Timor-Leste 250
Guinea-Bissau 88 Togo 158
Guyana 62 Tokelau 17
Haiti 136 Tonga 12
Honduras 35 Trinidad & Tobago 4
Hungary 12 Tunisia 10
Iceland 1 Turkey 12
India 75 Turkmenistan 30
Indonesia 115 Turks & Caicos Islands 9
Iran 12 Tuvalu 54
Iraq 52 Uganda 271
Ireland 5 Ukraine 43
Israel 4 United Arab Emirates 8
Italy 3 United Kingdom 5
Jamaica 3 UR Tanzania 150
Japan 13 Uruguay 12
Jordan 2 US Virgin Islands 5
Kazakhstan 66 USA 2
Kenya 168 Uzbekistan 52
Kiribati 75 Vanuatu 27
Kuwait 12 Venezuela 19
Kyrgyzstan 55 Viet Nam 79
Lao PDR 70 Wallis & Futuna Is 16
Latvia 31 West Bank and Gaza Strip 10
Lebanon 5 Yemen 40
Lesotho 282 Zambia 265
Liberia 124 Zimbabwe 260

 

The Recent TB Epidemic

The registered number of new cases of TB worldwide roughly correlates with economic conditions: the highest incidences are seen in those countries of Africa, Asia, and Latin America with the lowest gross national products. WHO estimates that eight million people get TB every year, of whom 95% live in developing countries. An estimated 3 million people die from TB every year.

In industrialized countries, the steady drop in TB incidence began to level off in the mid-1980s and then stagnated or even began to increase. Much of this rise can be at least partially attributed to a high rate of immigration from countries with a high incidence of TB. It is also difficult to perform epidemiological surveillance and treatment in immigrant communities due to various cultural differences.

A great influence in the rising TB trend is HIV infection. Chances are that only one out of ten immunocompetent people infected with M. tuberculosis will fall sick in their lifetimes, but among those with HIV, one in ten per year will develop active TB, while one in two or three tuberculin test positive AIDS patients will develop active TB. In many industrialized countries this is a tragedy for the patients involved, but it these cases make up only a small minority of TB cases. In developing countries, the impact of HIV infection on the TB situation, especially in the 20-35 age group, is worthy of concern.

A final factor contributing to the resurgence of TB is the emergence of multi-drug resistance. Drug resistance in TB occurs as a result of tubercle bacillus mutations. These mutations are not dependent upon the presence of the drug. Exposed to a single effective anti-TB medication, the predominant bacilli, sensitive to that drug, are killed; the few drug resistant mutants, likely to be present if the bacterial population is large, will, multiply freely. Since it is very unlikely that a single bacillus will spontaneously mutate to resistance to more than one drug, giving multiple effective drugs simultaneously will inhibit the multiplication of these resistant mutants. This is why it is absolutely essential to treat TB patients with the recommended four drug regimen of isoniazid, rifampin, pyrazinamide and ethambutol or streptomycin.

While wealthy industrialized countries with good public health care systems can be expected to keep TB under control, in much of the developing world a catastrophe awaits. It is crucially important that support be given to research efforts devoted to developing an effective TB vaccine, shortening the amount of time required to ascertain drug sensitivities, improving the diagnosis of TB, and creating new, highly effective anti-TB medications. Without support for such efforts, we run the risk of losing the battle against TB.
TBNI International
Millennium Goals: Burma Must Tackle TB and HIV
BANGKOK, Sep 5 (IPS) - For over 15 years a clinic in Mae Sot, a town along Thailand's north-western border, has offered a glimpse into how widespread tuberculosis (TB) is in neighbouring Burma.

It is to that clinic, run by Dr.Cynthia Maung, that a stream of poor men, women and children, escaping military-ruled Burma for Thailand, come to for a health check. ''In 2004 we detected 700 cases of TB, of which 250 needed treatment,'' said Maung, herself a refugee who fled Burma in 1988 following Rangoon's harsh crackdown on a pro-democracy movement.

TB remains one of the major diseases that the hundreds crossing over from Burma suffer from, she explained during a telephone interview from her clinic in Mae Sot. ''We are concerned because every year the cases are high''.

Similar conclusions have been reached by officials at Thailand's ministry of public health, given the number of TB cases that have been detected during mandatory health tests done to the thousands of migrants from Burma who seek legal employment in this country.

In 2003, for instance, there were 1,766 Burmese with TB who required follow-up treatment, states a health ministry study. The infection that followed TB was syphilis, with 952 cases.

In 2002, in the Tak province alone, where Mae Sot is located, Thai health officials had required 885 Burmese to commence medical treatment for TB. That was out of an estimated 30,000 migrant workers who were seeking jobs in the large agriculture farms and the many garment factories there.

The number of migrant workers with TB has added to the incidence rate of this killer disease in Thailand, compelling Bangkok to step up TB detection and treatment efforts. ''This year we put TB among one of the priority problems we have to tackle,'' Dr. Kamnuan Ungchasuk, director of the bureau of epidemiology at the health ministry, told IPS.

These numbers, however, are dwarfed by reports that Burma has 97,000 new cases of TB ever year and this South-east Asian nation is classified by the World Health Organisation (WHO) as being among the world's 22 'high burden'countries with the disease.

More troubling for public health experts is the high prevalence of multi-drug resistant TB (MDRTB) in Burma. It has four percent new cases of MDRTB, states the Geneva-based health body.

The frequency of MDRTB, which is incurable since it does not respond to available cheap anti-TB drugs, has placed Burma on the top of the list of afflicted countries in the region.

According to the WHO, Thailand has 0.9 percent of the new cases of MDRTB, Bangladesh has 1.4 percent new cases and even India, the country with the greatest TB burden, there are only 3.4 percent new MDRTB cases annually.

The only country in East Asia worse off than Burma for new MDRTB cases is China, with a reported 5.3 percent prevalence rate.

''The situation in Myanmar is a concern because four percent new cases in a high burden country is no trivial number of patients - several thousands, likely between 4,000-6,000 cases,'' a WHO official told IPS.

Such revelations about Burma, whose military rulers changed the country's name to Myanmar, come at a time when there is a global effort to rid the world of this pandemic, which kills nearly two million men, women and children every year.

As part of the Millennium Development Goals (MDGs), world leaders pledged at a U.N. summit in New York in 2000 to stop the spread of the world's leading killer diseases - AIDS, TB and malaria - by 2015.

Other MDGs to be achieved by that year include halving the number of those living on less than one US dollar a day, ensuring universal primary education for all boys and girls, reducing by two-thirds the number of children who die before reaching five years of age and reducing by three-fourths the number of women who die while giving birth.

And the WHO makes the alarming prediction of what the world will be faced with if TB, a curable infectious disease, is not overcome. In the next 20 years, almost one billion people will become newly infected, 200 million people will develop the disease and 35 million will die from it, it states.

It is a scenario made worse by the ease with which TB feeds off the other global pandemic, AIDS, which killed 3.1 million people last year. ''TB is the leading killer of people infected with HIV,'' states the WHO, due to the weak immune systems of those with the virus that causes AIDS.

Currently, some 14 million people are co-infected with TB and HIV, of which 70 percent are in Africa.

The likelihood of Burma adding to those numbers has grown in the light of the fact that the country has the second highest prevalence rate of HIV in South-east Asia with an estimated 170,000 to 620,000 people living with the killer disease, according to a U.N. agency.

And a decision by an international funding agency to pull out of Burma in August due to roadblocks imposed by the military regime -- consequently hampering its 98.4 million-dollar contributions for programmes to combat AIDS, TB and malaria - has set off more alarm bells.

Yet, the WHO feels that such concern, at least over TB, may be misplaced, since the junta has implemented a range of public health initiatives despite its limited resources and a weak health system.

''For a resource-constrained country, Myanmar has a well functioning TB programme and a very good laboratory, which should enable the country to address the problem of MDRTB,'' says the WHO official.

''Political commitment to DOTS is high in Myanmar,'' added the official, referring to the Directly Observed Treatment Short Course strategy of diagnosing and ensuring administration of cheap anti-TB drugs to patients.

''DOTS coverage is 100 percent, meaning that all of the 324 townships have a DOTS clinic, although access to services varies widely''.
The Human And Economic Impact Of TB
Tb And Poverty

Poverty, a lack of basic health services, poor nutrition and inadequate living conditions all contribute to the spread of TB. In turn, illness and death from TB reinforces and deepens poverty in many communities.

Across the globe, the poor are at greater risk of TB. Studies in India have shown that the prevalence of TB is between two and four times higher among groups with low income and no schooling. Overcrowded conditions, poor nutrition and inadequate sanitation increase the probability of being
infected and developing active TB. Once they are ill, those who have limited access to health services are less likely to be diagnosed and treated for TB. The greater the numbers of people with active TB in a community, the more likely others are to become infected. This becomes a vicious circle in poor communities where TB flourishes. Over 90% of TB cases and 90% of deaths from TB occur in developing countries.

A key challenge for TB control today is finding those people who have limited access to effective TB treatment and curing them. Expanding innovative approaches such as linking the public and private sectors in the treatment and referral of such cases will be critical in reducing TB deaths among the poor.

The Impact Of Tb On Women And Children

TB is a leading cause of death among women of reproductive age. One of the reasons for this is that women are less likely than men to be tested and treated for TB. In addition, as greater numbers of women become infected with HIV, more are also becoming sick with TB. Over 250 000 children die every year of TB. Children are particularly vulnerable to TB infection because of frequent household contact. Children also suffer when their parents are infected. Every year in India alone, more than 300 000 children leave school on account of their parents’ TB.

The Socioeconomic Impact

Because TB typically affects the most productive and economically active segments of the population, the impact of illness on communities and households is very high. TB costs borne by the patient often exceed costs to the health ministry.

The socioeconomic burden of TB is frequently discussed in terms of the direct and indirect costs to households. These costs are higher for TB than most other diseases due to the length of the treatment period (six to eight months). Direct costs include paying for visits to clinics, tests and drugs. In addition, TB imposes high non-medical costs, such as the cost of additional nourishing foods and transport to and from clinics. The indirect costs of a long illness are also devastating for poor households. These include lost household income and production (such as food), adverse impacts on the health and education of family members (withdrawal of children from school) and the costs of sub-optimal land use.

  • More than 75% of TB-related disease and death occurs among people between the ages of 15 to 54, the most economically active segment of the population.

  • TB is estimated to deplete the incomes of the world's poorest communities by a total of US$ 12billion per year.

  • The potential cost of lost productivity due to TB is in the order of 4 to 7% of GDP.

  • The average TB patient loses three to four months of work time as a result of being sick; loss of household earnings ranges from 30 to 100%.

  • Mean household spending on TB amounts to 8- 20% of the annual household income, varying by region.

In developing countries with few government safety nets, diseases like TB have a devastating impact on poor households which must resort to various coping strategies. Some of these strategies include reducing the quality and quantity of food in order to save money, selling assets, taking out loans and withdrawing children from school. Many of these strategies undermine the household’s long-term sustainability and ability to survive future shocks.

STATUS OF GLOBAL PLAN UPDATES - July 3, 2007

Click here to view PDF


Global Plan to Stop TB
The Global Plan to Stop Tuberculosis is a comprehensive assessment of the action and resources needed to expand, adapt and improve the globally recommended strategy for TB control. The First Global Plan to Stop TB (2000-2005) described mechanisms, activities and resources needed to accelerate progress towards 2005 targets and plans of action of the Stop TB working groups. The Second Global Plan to Stop TB (2006-2015) features a 10 years' timeframe, responds to country needs for long-term planning and financial sustainability and is consistent with the proposed World Health Assembly resolution in 2005 calling for a Global Plan. The Global Plan provides a roadmap for achieving the Stop TB Partnership's global TB control targets for 2015 (that are linked to the Millennium Development Goals), i.e. to halve TB prevalence and deaths by 2015 in comparison with 1990. These targets represent progress towards the goal to eliminate TB as a global public health problem by 2050.

The Stop TB Partnership Secretariat is pleased to use this website as a tool to update its partners on its progress. All questions or suggestions related to the overall Global Plan can be emailed to globalplan@stoptb.org

Meeting of the Steering Committee for the Global Plan to Stop TB (2006-2015)
2 May 2005 - Addis Ababa, Ethiopia

The Coordinating Board has established a Steering Committee that provided useful guidance concerning the finalization of the 7 Working Groups (WG) Plans and the overall Global Plan. The Steering Committee reviewed each draft WG strategic plan and regional scenario; considered issues relating to the overall Plan, including the Plan’s vision, timetable, and processes; and agreed the next steps in developing the Plan. The Stop TB Coordinating Board at its meeting session on 4 May 2005 noted the Steering Committee’s decisions and considered its recommendations. (Point 5 - Part 2 of report below).

Finalised WG plans are due by the end of May 2005. In addition to consultation through the WGs, the Secretariat will organise an extensive review process in August-September 2005.

The Stop TB Coordinating Board endorsed the proposal of the World Economic Forum to launch the Global Plan during its Annual Meeting at Davos from 25-29 January 2006.

The report of the meeting can be downloaded from here.

The 7 draft WG Strategic Plans are as follows:

DOTS Expansion
DOTS-Plus
TB/HIV
New Diagnostics
New Drugs
New Vaccines
Advocacy, Communications and Social Mobilization

The table below provides a summary timetable for producing the Global Plan. A more detailed timetable is attached at Annex 2 of the Steering Committee meeting report.

Global Plan to Stop TB (2006-2015): summary revised timetable
Date Milestone
2 May Global Plan Steering Committee meeting
4 May
Coordinating Board consideration of Global Plan issues
End May Finalised WG plans and regional scenarios
June - July Drafting of first full Global Plan
August - September Wide consultation and review
End September Finalised Global Plan
October - December
Development of advocacy materials.Production of Global Plan (editing, design, translation, printing etc)
Late January 2006
Launch of Plan at the World Economic Forum Annual Meeting, Davos, 25-29 January 2006

Update on Global Plan to Stop TB 2006-2015


The Stop TB Partnership secretariat is coordinating the development of the Second Global Plan to Stop TB (2006-2015), under the guidance of the Steering Committee.* The Plan represents a roadmap for TB control over the next decade (2006-2015), in working towards the goal to eliminate TB as a global public health problem by 2050. Work started in May 2004 with building consensus among Stop TB partners on the outline of the Plan. The Plan will set out the action needed to reach the 2015 global targets for TB control, which are part of the United Nations (UN) Millennium Development Goals (MDGs). The global target is to halve TB prevalence and deaths by 2015 in comparison with 1990.

The development of a strategic plan (2006-2015) by each Working Group (WG) is crucial to the successful development and subsequent implementation of the Global Plan. The WGs have much to gain from the successful development of a global plan with wide support. At its meeting in Beijing in October 2004, the Coordinating Board requested each WG to develop its own strategic plan (2006-2015) in contribution to the overall Global Plan. The WG chairpersons and secretaries met in Beijing on 16 October 2004 straight after the Coordinating Board meeting to discuss the planning process for the WGs' contributions to the Global Plan. For each WG this involves planning the activities (ultimately with timelines and milestones) necessary to contribute to achieving the 2015 global TB control targets, with the accompanying costs.

The initial step in the planning process is to construct possible scenarios which consider how the activities of the seven WGs could, separately and together, contribute to reaching the targets in 2015. It is necessary to consider how the regions individually and the world overall can reach the 2015 global TB control targets. This work on epidemiological and costing projections will provide each WG with the basis for developing its strategic workplan in contribution to achieving the 2015 global targets. This planning process requires close interaction between the representatives of the seven WGs and the team assessing the epidemiological impact of the currently available and new tools.

At a planning workshop in Montreux, Switzerland (28 February to 4 March 2005), WG focal points (identified by each WG chairpersons and secretary) and the team assessing epidemiological impact will present and refine scenarios representing how the activities of each WG could contribute to global TB control. Developing the scenarios will build on work already done by some WGs in modelling the expected impact of their activities.

The Steering Committee will meet in April 2005 to review progress in developing the WGs' strategic plans in contribution to the Global Plan. The Coordinating Board's target date for the Global Plan's launch is the end of 2005. Successful development and implementation of the WG strategic plans depends on the involvement of a wide range of members of each WG. Table 1 shows the chairpersons and secretaries of the seven WGs who you should contact to indicate your interest. Please contact Dermot Maher (maherd@who.ch) regarding the overall Global Plan.

*Olusoji Adeyi (USA), Faruque Ahmed (Bangladesh), Nils Billo (France), Jaap Broekmans (Netherlands), Ken Castro (USA), Marcos Espinal (Switzerland), Maria Freire (USA), Phil Hopewell (USA), PR Narayanan (India), Francis Omaswa (Uganda), Mario Raviglione (Switzerland), Karam Shah (Pakistan), Roberto Tapia (Mexico), Irene Koek (USA), Edugie Abebe (Nigeria)

Table 1. Chairpersons and secretaries of the Working Groups
 
Working Group Secretary Chairperson
DOTS Expansion Léopold Blanc Karam Shah
TB/HIV Paul Nunn Gijs Elzinga
DOTS-Plus Kitty Lambregts Kai Vink
New drugs Barbara Laughon Maria Freire
New diagnostics Jane Cunningham Giorgio Roscigno
New vaccines Uli Fruth Douglas Young
Advocacy and
Communication		 Michael Luhan Joanne Carter

 

The Plan sets out actions for life - actions towards a world free of TB

PART I: Strategic Directions

Achievements in 2000 - 2005 and Challenges for 2006 - 2015
This section provides a brief description of the Partnership's structure and function, outlines the main achievements in global TB control since 2000, describes the current TB situation today, and sets out the challenges that lie ahead.

Achieving the Targets: What Needs to be Done
In setting out the main strategic directions to achieve global targets for TB control, this section indicates the following:

  • the Partnership's vision, mission, and targets
  • the Partnership's strategic directions and objectives
  • the ways in which wider and wiser use may be made of existing strategies for TB control
  • strategies to address the challenges posed by emerging threats such as MDR-TB and HIV
  • the importance of operational research
  • the ways in which new TB diagnostic tests, drugs, and vaccines will be developed and adopted
  • the importance of technical cooperation in support of the implementation of effective TB control interventions
  • the main approaches to monitoring and evaluation

Key Cross-Cutting Issues: Strengthening Health Systems, TB and Poverty, TB in Children, and TB and Gender

As the Partnership’s working groups take forward their individual strategic plans for 2006 - 2015, they will work within the overall holistic vision of the Global Plan to Stop TB. To do this, the Working Groups have to work together effectively and efficiently, and to take a common approach to key cross-cutting issues. This section addresses four such issues important to the Global Plan: health system strengthening, poverty, TB in children, and TB and gender.

Summary of Planned Achievements, Resource Needs and Impact
This section summarizes:

  • what would be achieved if the Plan is fully implemented
  • the resource needs to enable full implementation of the Plan
  • the expected impact of full implementation of the Plan on the TB epidemic

PART II:GLOBAL & REGIONAL SCENARIOS FOR TB
CONTROL 2006 - 2015


PART III:PARTNERSHIP ACTION TO ACHIEVE GOALS
The entire details of The Global Plan to Stop TB 2006 – 2015 can be read on the link mentioned below.
http://www.stoptb.org/globalplan/plan_p1main.asp?p=1

 

 

 
Global TB

South-East Asia accounts for nearly 40% of all tuberculosis cases

South East Asia accounts for approximately 40% – two out of five – cases of tuberculosis in the world. Within South-East Asia, more than 95% of cases are found in India, Indonesia, Bangladesh, Thailand, and Myanmar.
Source: Global Tuberculosis Control: WHO Report 1999 (WHO/TB/99.259)




TB is the leading single infectious cause of death in South-East Asia

TB is the leading infectious cause of death among people more than 5 years of age in South-East Asia. In fact, it is projected that although morality from many other infectious diseases will continue to decrease over the next 20 years, TB will remain one of the 10 leading causes of death unless urgent action is taken. Source: World Health Report, 1999.

World Health Organization - Global Tuberculosis Control.

Source: WHO Report 2001. Geneva, Switzerland.
 

During 2000, a standard data collection form was sent to 211 countries via WHO Regional Offices. The form has three sections which request information about: policy and practice in TB control; the number and types of TB cases notified in 1999; and the outcomes of treatment and retreatment (DOTS areas only) for smear-positive or culture-positive (mainly Europe) cases registered in 1998.

The main findings were:

  1. There were an estimated 8.4 million new tuberculosis cases in 1999, up from 8.0 million in 1997; the rise is due largely to a 20% increase in incidence in African countries most affected by the epidemic of HIV/AIDS. If present trends continue, 10.2 million new cases are expected in 2005, and Africa will have more cases than any other WHO Region.
  2. Following a decade of successful control, and the consequent reduction in incidence, Peru fell to bottom place in the league of high-burden countries in 1999. It was eliminated from TB80 during 2000.
  3. The number of countries implementing the DOTS strategy (at least in part) increased by 8 during 1999, bringing the total to 127 (out of 211).
  4. The fraction of the world's population that had access, in principle, to DOTS increased slightly from 43% in 1998 to 45% in 1999.
  5. Roughly one quarter (23%) of estimated new smear-positive cases were reported to DOTS programmes in 1999, as compared with 22% in 1998; this is consistent with the average increment of about 120 000 cases in each year since 1994.
  6. If this trend is maintained, the target of 70% case detection under DOTS will not be reached until 2013; to get to the target by 2005, DOTS programmes must collectively recruit at least 300 000 additional smear-positive cases each year.
  7. There was an insignificant increase between 1998 and 1999 in the total number of smear positive cases reported to WHO; about 1.4 million cases were reported in both years (41% of the estimated total).
  8. Almost all (92%) of the progress in DOTS expansion, as judged by smear-positive case notifications, was made in just 5 countries; 65% of these additional cases were found in 2 countries, India and South Africa.
  9. Treatment success of new smear-positive patients has remained high under DOTS, and exceeded 80% in the most recent cohort (1998).
  10. Against expectation, the cure rate measured by sputum smear conversion in 12 European countries was not consistently higher than the cure rate measured by culture conversion; in order to explain this result, treatment outcomes must be examined for patients individually, rather than in aggregate.
  11. In 1999, Peru and Viet Nam were still the only high-burden countries to have exceeded both WHO targets of 70% case detection and 85% treatment success. However, several other TB80 countries are within reach: they include Brazil, Cambodia, Kenya, the Philippines, South Africa and Tanzania.
  12. A number of smaller countries appear to have declining TB incidence rates that are linked to high rates of case detection and cure; these include Cuba, Lebanon, the Maldives, Nicaragua, Oman and Uruguay.
  13. During the preparation of this report, China announced preliminary results of a nationwide survey suggesting a comparatively large reduction in TB prevalence in 13 provinces that have participated in the IEDC TB control project since 1990.
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