1. TUBERCULOSIS BURDEN IN LEBANON(between NTP and LATA) By Dr Antoine SAADE President of LATA CAIRO – 57th CONFERENCE OF ESCT

2. GLOBAL TUBERCULOSIS HISTORY Tuberculosis is one of the oldest diseases, known in Egypt of pharaohs and other ancient civilizations. Until mid-1880s many believed TB was hereditary.It has been widely spread in the industrialized societies during the second half of the nineteenth century, and was the first cause of mortality during that time. In 1865 Villemin proved TB was contagious and the cause of the disease has been discovered by Robert Koch in 24 March 1882. This date remains essential on the TB agenda and became known as “World TB Day.“ First sanatorium established in US 1884 The first drug that could kill TB was discovered 1943

3. IMPORTANT DATES OF TB STRUGGLE IN LEBANON – The first medical society to fight TB 1906 – Establishing of the first sanatorium 1908 – Opening of the chest diseases clinic Karantina Beirut 1950 – Launch of UNRWA ward for Palestinians patients in sanatorium of Dahr el Bachek in the presence of the Director of UNRWA 1955 – The introduction of Rifampicin to the Lebanese market 1968 – Launching of the National Programme against Tuberculosis 1992

4. IMPORTANT DATES OF TB STRUGGLE IN LEBANON – Start implementation of the Dots strategy (DOTS) 1998 – DOTS all over 2000 – Treatment of MDR TB patients 2005 – Starting PAL strategy 2007 – Start using the fixed dose combination (FDCs)2007 – Launching of LATA 2014

5. HISTORICAL ASPECT of TB in LEBANON First period: 1900 to 1930 rest fresh air and adequate food Second period: 1930-1950,surgical period, pneumothorax and other surgical treatments. Third period : 1950-1975 Discovering of Anti –TB drugs and TB regimens Fourth period: period of civil war (1976-1990), and emergence of TB drug resistance. Fifth period started with the launching of the National TB Program in 1992

6. Achievements of the Programme Foundation and activation of multiple TB centers covering all Lebanese regions. Close Collaboration between NTP, other public sectors and and private health sector. Cooperation and coordination with medical schools and unification of TB curricula, promoting ISTC. Creation of a laboratory network.

7. Achievements of the Programme Implementation of DOTS strategy in all Lebanese regions(since 2000) Drugs procurement without interruption since the foundation of the programme. Introduction of FDCs since 2007. Keeping a number of beds in sanatorium Starting the implementation of DOTS-PLUS strategy for MDR patients as of may 2005 Introducing by the year 2007 of the PAL strategy

8. TREND OF TB IN LEBANON

10. CHALLENGES The main challenge for the NTP is the increasing number of non national TB patients, especially Syrian displaced population 109 TB cases are detected during 2014 among Syrians when the expected number is turning around 400 to 500 TB patients.

11. NGOs AND TB CONTROL Many organizations were founded since the beginning of the 20 th century: the healthy TB Society shelter (1909-1923), the society of General Women's pity (1909-1923) and the TB control Association (1920-1923). All these organizations were unified later under the name of “ Daher Elbachek TB control association”, which has become a member of the International Union Against Tuberculosis(the union). Recently, by the end of 2014, a new organization is born, LATA, the Lebanese Anti TB Association

12. WHAT IS LATA It is a Lebanese anti-TB association, operates on the Lebanese territory in order to control tuberculosis and seeks to achieve the MDG and the WHO strategy to END TB. Its actual role is the dissemination of information and TB data on a broader scale and through the media Support of TB patients and their families, according to the material possibilities of the association. Development of relationships with national and international organizations and participation into scientific meetings and conferences at the national and international levels.

13. LATA ACTIVITIES We are a young anti TB association, born by the end of 2014 www.latalebanon.org Members of the association. Different background a strategic plan for the next 3 years has been elaborated Hotline to support all tuberculosis problems that could face doctors or patients in Lebanon. Conducting periodical conference at provincial level(TB in Lebanon, MDR….)

14. NATIONAL ACTIVITIES LATA participated to the 1er CONGRES DE LUTTE CONTRE LES INFECTIONS ASSOCIEES AUX SOINS(11 September 2015) Beirut –Lebanon and presented profile of MDR at global and national level LATA prepared and managed the memorization of TB day, 24 Mach 2016, Beirut Lebanon The event was celebrated with eminent international and national speakers(including Egypt representative)

15. INTERNATIONAL ACTIVITIES First international activity was in collaboration with WHO, during November 2015 in Addis Ababa, Ethiopia. the selection of WHO consultation with NGOs and CSOs was based on online consultation during July-August 2015, with 700 NGOs from 73 countries. 89 NGOs from 37 countries have been selected(including LATA Lebanon) and more than 150 participants.(including LATA president) Our participation to the 57 th conference of ESCT.

16. PRIORITIES OF LATA Continue the cycle of advocacy and awareness about TB Management of vulnerable and special population as MDR, TB/HIV, prisoners, displaced population and refugees. Under the umbrella of the MOPH-Lebanon, prepare a strategic plan to control and eliminate TB Join our effort for the TB elimination in the eastern Mediterranean region Prepare a plan for joint action on the level of Arab Eastern Mediterranean countries (pan Arab TB association)

18. THANKS FOR YOUR ATTENTION LATA LEBANON www.latalebanon.org