1 Global and Regional Tuberculosis (TB) update ACSM workshop, Amman, Jordan April 13-17, 2008 Dr. Sevil Huseynova

2 What is TB?  One of the oldest disease known  Usually a respiratory disease due to infection by Mycobacterium tuberculosis.  Mode of spread TB Patient  Cough   infect others

3 How big TB problem is? Leading infectious killer in the world  Globally: 2.1 billion infected 9.2 million cases & 1.7 million deaths a year 0.7M cases & 0.2M deaths in HIV+ 500K people a year become infected with MDR-TB  25% of all avoidable deaths in economically productive age groups are due to TB.  Regionally: 180M infected 560,000 cases & 110,000 deaths a year Yet it is completely curable and is (relatively) inexpensive to cure.

4 Estimated TB incidence rate, 2006 Estimated new TB cases (all forms) per population The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.  WHO All rights reserved No estimate or more

5 Estimated HIV prevalence in new TB cases, 2006 No estimate 0–4 20–49 50 or more 5–19 HIV prevalence in TB cases, (%) The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.  WHO All rights reserved

6 > 100 Incidence rate (/ ) < 20 Bahrain Palestine Estimated TB incidence rate in EMR WHO Global TB Report 2007

7 How to fight against TB? Global Plan to Stop TB  Comprehensive plan to achieve 70/85 & MDG ( )  Activities & Cost  USD 56 Billion for world  USD 3.1 Billion for EMR

8 Global Plan to Stop TB: Goals, Targets and Strategies for TB control MILLENIUM DEVELOPMENT GOAL 6 Combat HIV/AIDS, malaria and other diseases Target 8: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases Indicator 23: The global burden of TB (per capita prevalence and death rates) will be reduced by 50% relative to 1990 levels  Prevalence 50% of ≈ 300/100K  Deaths 50% of ≈ 30/100K (< 1m deaths) Indicator 24: proportion of TB cases detected and cured under DOTS  Case detection 70% (> 6 m diagnosed)  Treatment success 85% (> 5 m cured DOTS) By 2050: The global incidence of active TB will be less than 1 case per million population per year (Stop TB Partnership).

9 DOTS status in 2006: countries close to targets 99 countries reported treatment success rates 70% or over and DOTS detection rates 50% or over 32 countries (including 2 countries out of range of graph) have reached both targets.

10 The components of the Stop TB Strategy ( ) 1.DOTS expansion and enhancement 2.Addressing TB/HIV, MDR-TB and other challenges 3.Contributing to health system strengthening 4.Engaging all care providers 5.Empowering patients, and communities 6.Enabling and promoting research

11 WHO Stop TB Strategy & “DOTS” Care for TB patients & community participation in TB control Diagnosis by laboratory (sputum examination) 6 month treatment with >95% efficacy Strategy to involve private sector & community e.g. cure rate is above 85% in most EMR countries

12 What are the challenges in TB care? 1.Low health priority 2.Limited resources (human and financial) 3.Low case detection and Treatment adherence, Drug resistance  Stigma and discrimination  Poverty  Wars and conflicts  HIV/AIDS and TB  Mobile population and migration