Session 11: MDR & XDR-TB: How Can Business Help Stem the Tide? Overview of Global MDR-TB/XDR-TB Issues & Bottlenecks to Fighting the Epidemic Ernesto Jaramillo WHO/Stop TB Department

Definitions of TB, MDR-TB, XDR-TB Source of data: - TB: best performing NTP from HBCs - MDR-TB: average from GLC-approved sites - XDR-TB: well performing MDR-TB treatment programme in absence of HIV

Estimated number of cases Estimated number of deaths The global burden of TB in 2008 Estimated number of cases Estimated number of deaths All forms of TB 1.3 million* 9.37 million HIV-associated TB 0.52 million This slide that contains all essential numbers WHO estimates that worldwide in 2007 over 9 million TB cases occurred (and of those, 4 million infectious, sputum-smear (+)). 1.65 million people died of TB, which means 4500 every day. WHO estimates, based on surveys conducted in over 110 settings in the last decade, that nearly half a million cases are multi-drug resistant, and 130,000 of them lethal WHO estimates that XDR-TB cases, which are resistant to all most potent first-line and second-line, reserve drugs, were about 50,000, the majority of which are lethal. Finally, well over 700,000 cases of the 9 million are linked with HIV/AIDS. This is slightly less than 10%. In Africa, this % is much higher, up to50%. In the rest of the world, however, the vast majority of TB cases are not due to HIV. 1.4 million (15%) Multidrug-resistant TB (MDR-TB) 440,000 >150,000 *excluding deaths among HIV+ people

TB incidence rates falling globally after peak in 2004 1990 1995 2000 2005 Peak in 2004 150 Rate per 100,000 population 145 140 135 130 World as a whole on track to achieve MDG target 6.c 125 120

M/XDR-TB 2010 global report on surveillance and response Detection & Diagnosis Only 7% of all estimated; US$87 million EXPAND-TB project scaling-up access in 27 countries Treatment Success 60% ! Country response 20/27 high MDR-TB countries strengthening MDR-TB components of TB control national plans This report presents drug resistance data from 114 countries and updated information from 35 of them. Despite the growing understanding of the magnitude and trends in drug-resistant TB, major gaps remain in geographical areas covered. Since 1994, only 59% of all countries globally have been able to collect high quality representative data on drug resistance. There is an urgent need to obtain information, particularly from Africa and those high MDR-TB burden countries where data have never been reported: Bangladesh, Belarus, Kyrgyzstan, Pakistan and Nigeria. Moreover, countries need to expand the scope of their surveys to cover entire populations, repeat surveys are needed to better understand trends in drug resistance and countries need to move towards adopting systematic continuous surveillance. 

Orel Oblast, Russian Federation Tomsk Oblast, Russian Federation Trends of MDR-TB cases in selected settings Orel Oblast, Russian Federation Tomsk Oblast, Russian Federation New MDR-TB cases 10 20 30 40 50 1994 1996 1998 2000 2002 2004 2006 2008 Year Cases notified New MDR-TB cases 20 40 60 80 100 1994 1996 1998 2000 2002 2004 2006 2008 Year Cases notified

MDR-TB epidemic: Global challenge No treatment reported. Some treatment probably obtained, quality unknown 440,000 estimated cases in 2008 Countries report treatment, standard unknown (7%, including GLC programmes) 7% 3% Treated in GLC approved programmes 7

27 high MDR-TB burden countries Progress of MDR-TB care very slow Global Plan* To reach targets, scale-up required in India, China and Russian Federation in particular Actual or expected progress Global target mdr/xdr response plan about 100,000 for 2008; current plans for about 50,000 *Based on Global MDR/XDR-TB Response Plan, 2007, updated for high-level Ministerial meeting on MDR/XDR-TB in Beijing, April 2009

We have political commitment from national governments

High-level policy changes are fundamental High-level policy changes are fundamental! World Health Assembly, May 2009… In addition to high quality DOTS... Remove financial barriers (UHC) Ensure well trained and sufficient human resources Establish a network of labs where rapid tests are also available Ensure availability of quality drugs Regulate the use of all anti-TB drugs Introduce infection control Establish proper surveillance Promote Research & Development Address social determinants and risk factors Mobilize resources domestically and internationally Document WHA 62.15, 2009

Countries, WHO and the Stop TB Partnership have strong partners, but…