1. Current Aspects of TB in Egypt and other EMR countries Dr. Essam Elmoghazy Chairman of Cairo Association against Smoking, Tuberculosis and Lung diseases- Egypt (CASTLE) Chairman of the Green Light Committee_EMR 2016

2. The year 2015 is a watershed moment in the battle against tuberculosis (TB). It marks the deadline for global TB targets set in the context of the Millennium Development Goals (MDGs), and is a year of transitions: from the MDGs to a new era of Sustainable Development Goals (SDGs), and from the Stop TB Strategy to the End TB Strategy. 2015

3. In 2014, there were an estimated 9.6 million incident cases of TB (range, 9.1 million–10.0 million) globally, equivalent to 133 cases per 100 000 population Most of the estimated number of cases in 2014 occurred in Asia (58%) African Region (28%); Eastern Mediterranean Region (8%), European Region (3%) Americas (3%). Global TB Burden: 2014 estimates

4. Global TB cases South-East Asia 38% Western Pacific 18% Africa 29% E. Mediterranean 8% Europe 4% Americas 3% 34% in India + China 23% in India

5. TB Situation in EMR

6. WHO Eastern Mediterranean Region WHO MEMBER STATES: 21 Prevalence rate 160 (per 100 000 population) Incidence rate 117 (per 100 000 population) Case detection rate, all forms 61% % of TB cases with MDR-TB: new 3.2%, retreatment 18%

7. WHO Eastern Mediterranean Region Nine countries contribute 95% of the TB burden in the Region. These are Pakistan Afghanistan, Sudan, Morocco, Somalia, Iraq, Egypt, Iran and Yemen. Pakistan alone shoulders 61% the TB burden of the Region.

10. The progress A significant decline in the regional rates of TB prevalence and mortality has been reported. The Region has achieved the global target of halving TB mortality compared to 1990. Reductions in prevalence have been considerable since 1990, and appear to have accelerated since 2000. Nonetheless, current forecasts suggest that the Region needs to do more to achieve the 2015 target of halving prevalence compared to 1990. However, the incidence of TB in the Region declined at a low rate of less than 1% per year from 1990 to 2013. The Region has achieved a high treatment success rate of 88% for more than 5 years. As for multidrug-resistant TB (MDR-TB), the Region has a low burden of 3.5% of new TB cases and 32% of previously-treated cases. Most countries in the Region have established MDR-TB management in line with WHO guidance. However, it is estimated that the Region has only detected 12% of MDR-TB cases and has enrolled 72% of these cases on treatment.

11. TB Situation in Egypt

12. Estimates of burdenNumber (thousands) Rate (per 100 000 pop) Mortality (excludes HIV+TB) 0.31(0.29–0.34)0.37(0.35–0.4) Prevalence (includes HIV+TB) 21(11–34)25(13–41) Incidence (includes HIV+TB) 12(11–14)15(13 - 17) Case detection, TB all forms58%(51% – 66%)

13. In terms of incidence of tuberculosis, Egypt is ranked among the mid-level incidence countries. Tuberculosis in Egypt is considered an important public health problem.

14. New SS+veNew SS-ve Extra Pulm. Relapse TTT Failure TAIOthersTotal NTP 2740729180728291109715829 Prison 154534223173 HIO 2497615917113506 University 204452020000451 Non National 27217213153 African ref 19412120038 Army chest hospitals 1770210000198 Police 90000009 fever hospitals 00000000 Private sector 11825643000210 Total 369788622853099711578 7467

16. Burden of MDR The prevalence rate of MDR is 2.2% among new TB patients 38.4% among retreated cases (Drug resistance survey 2002). 3.4% in new 15% in retreated cases (Drug resistance survey 2011).

17. MDR-TB management in Egypt The first MDR-TB center was established in Abbassia chest hospital and patient enrolled in June 2006. Later on, another two centers were established, one in Maamoura chest hospital in 2008 and a third one in Mansoura chest hospital in 2012 A fourth center is being prepared now in Asuit chest hospital. Second line drugs used in management of theses cases are funded from global fund grant. The average treatment course costs around 4000 US$ and lasts up to two years compared to 6 months for susceptible tuberculosis and less than a 1000 EP. From 2006 to 2015 ( 500 patients enrolled in the treatment) with success treatment 68%

18. MDR-TB management in Egypt The first MDR-TB center was established in Abbassia chest hospital and patient enrolled in June 2006. Later on, another two centers were established, one in Maamoura chest hospital in 2008 and a third one in Mansoura chest hospital in 2012 A fourth center is being prepared now in Asuit chest hospital. Second line drugs used in management of theses cases are funded from global fund grant. The average treatment course costs around 4000 US$ and lasts up to two years compared to 6 months for susceptible tuberculosis and less than a 1000 EP. From 2006 to 2015 ( 500 patients enrolled in the treatment) with success treatment 68%

19. Thank you