1. Dr Ral Antic Chair, Scientific Committee IUATLD-APR Australia
Tuberculosis Control in the Asia Pacific Region   
Achievements, Deficiencies & Future Directions 
Dr Ral Antic
Chair, Scientific Committee IUATLD-APR
Australia

2. The 1st Asian Pacific Regional Conference 2007, IUATLD - APR
‘OVERCOMING AN OLD SCOURGE WITH A NEW FACE’

3. The 1st Asian Pacific Regional Conference 2007, IUATLD - APR
‘OVERCOMING AN OLD SCOURGE WITH A NEW FACE’
We could have (& have) been discussing, in this context
Tuberculosis
COPD
Asthma
Sleep Disorders ……. & others

4. Achievements in the last decade
What is different in the handling of these various disorders is
The extent of the global and regional strategic planning for TB
The structured multi-faceted public health approach as we have discussed
That we are driving the ‘change agenda’ working back from defined targets and outcomes

5. Achievements and Deficiencies in TB
Global, Regional & Country
What are we trying to achieve?
Are our Directions and Targets right and achievable
Do we have the ‘capacity’ to achieve the Vision, Goals and Targets we have set?

6. Achievements in TB in the last decade
The provision of effective Global, Regional and Country Leadership
A sustained focus on development and updating of a Global and Regional Strategic Direction
Its implementation in a strategic fashion
Improvement in case detection and treatment
Infrastructure building
Better Surveillance and Quality monitoring

7. Achievements and Deficiencies
Global, Regional & Country
In the last decade, we have appropriately changed direction
But with the current tools, change is understandably slow.
And this leaves us to wonder whether we are doing a good job.

8. Achievements and Deficiencies
Global, Regional & Country
What is the burden of ill-health from TB ?

9. The Global TB Epidemic ‘Global TB Control’ , WHO Report 2007
TB is still a major cause of death worldwide, but the global epidemic is on the threshold of decline
TB prevalence and death rates have probably been falling globally for several years
But the total number of new TB cases is still rising slowly, as the population grows and the case-load continues to grow in the African, Eastern Mediterranean and SEA Regions

10. Estimated Burden from TB and Trends Western Pacific Region
Estimated 4 million cases of TB in WPR
2 million new cases
Seven high burden countries account for >95%
Cambodia, China, Lao PDR, Mongolia, PNG, Philippines & Vietnam

11. Stop TB Partnership Targets
By 2005: At least 70% of people with sputum smear-positive TB will be diagnosed (i.e. under the DOTS strategy), and at least 85% cured
By 2015: The global burden of TB (per capita prevalence and death rates) will be reduced by 50% relative to 1990 levels
By 2050: The global incidence of active TB will be less than 1 case per million population/year

12. WP Regional Goals & Targets Regional Committee WPR, 2000
Reduce TB prevalence and mortality by 50% in 2010 compared with 2000
Intermediate Targets (towards this goal):
Detect 70% of estimated active cases
Treat successfully 85% of these cases
100% DOTS coverage

13. What we have achieved in WPR
WPR achieved these intermediate targets in 2005.
Also
26 countries globally have achieved targets - including China, the Philippines, Vietnam
Targets were missed narrowly Globally:
case detection %
treatment success - 84%
Treatment success in the SEA Region > 85%

14. MDR-TB and XDR-TB ‘The Global MDR-TB and XDR-TB Response Plan 2007-2008’ WHO Report 2007
> new cases of MDR-TB every year
due to under investment in basic TB control, poor management of anti-TB drugs and transmission of drug-resistant strains.
MDR-TB is much more difficult and costly to treat than drug susceptible TB
recent work has shown that it is feasible and cost-effective to treat even in settings of limited resources.

15. MDR-TB and XDR-TB ‘The Global MDR-TB and XDR-TB Response Plan 2007-2008’ WHO Report 2007
Emerging XDR-TB
The economic, social and health security of countries and communities with a high prevalence of TB threatened by it
It is virtually untreatable TB among the bread-winners, parents and economically productive age groups.

16. MDR-TB and XDR-TB ‘The Global MDR-TB and XDR-TB Response Plan 2007-2008’ WHO Report 2007
Strengthening the coverage and quality of basic TB control is the first and most important measure to prevent MDR-TB and is the fundamental platform for deploying management of drug resistant TB
Treat 1.6 rather than 0.8 million in 2008 with MDR-TB and save lives
More costly >US$ 2.1B extra

17. Case Detection in WPR From < 40% to >70% overall in 5 years
Achieved by:
Developing a strategic approach, The Global Plan to Stop TB
Strengthening political commitment
Accelerating DOTS expansion in public facilities
Higher case detection success in many countries
TB care more available and accessible
Improving collaboration of health care providers
Increase in financing and other resources

18. TB Performance Indicators in the Western Pacific Region, 2004
“Strategic Plan to Stop TB in the Western Pacific 2006 – 2010”
Prevalance Rate (/105)
Case detection
SS+ (%)
Treatment Success (%)
Mortality Rate (/105)
Australia 6 56 95 1
Cambodia
709 61 93 94
China
221 65 17
Hong Kong 77 72 78
Japan 39 62 76 4
Lao PDR
318 55 79 25
Malaysia
133 69 16
Mongolia
209 80 87 24
New Zealand 11 59 36
Papua New Guinea
448 31 58 42
Philippines
463 73 88 48
Republic of Korea
125 82 10
Singapore 41 67
Vietnam
232 89 92 22
TB Performance Indicators in the South East Asia Region, 2004
“National Tuberculosis Control Programs South East Asia Region”
Indonesia
262 66 90
Thailand
218 74 20

19. Some future barriers to TB Control
Poverty, Housing, Social disruption
The under-diagnosis of TB
Perceived complexity of the public health systems we are promoting
Natural progression of resistance in drugs
The benefits and risks of having joint project eg malaria, smoking cessation, HIV-TB

20. Towards the Goals and Targets
Although the TB burden may be falling globally, the decline is not fast enough to meet the impact targets
“Strategic Plan to Stop TB in the Western Pacific 2006 – 2010”

21. Estimated Trends Western Pacific Region
A decline of 15% in prevalence & 12% in mortality between
Annual average of 4% and 3% respectively

22. Will achieving WHO targets reduce the notification rate?
The barriers
Spread of HIV
Accumulation of MDR-TB cases
Insufficient access to high quality TB care for the poor and vulnerable populations and in private sector
Lack of national guidelines & training materials
Lack of human resources and their development
AND/OR
the rising numbers and urbanisation of the population
Estimated targets and actual incidence need discussion

23. 3 main areas of concern
The current level of 70% detection will not be sufficient
MDR-TB and TB-HIV co-infection will slow the annual decline
Conventional DOTS service delivery does not guarantee equitable access to TB Services

24. The current position
A new ‘Strategic Plan to Stop TB in the Western Pacific ’ has been developed to achieve the new targets.

25. The new Strategic Plan for WPR 2006-2010
To achieve the 50% reduction in prevalence & death rates, an 8% annual decline is needed
The current annual decline is 3-4%
There thus needs to be a change in approach
This is the basis of the strengthened effort defined in the new Strategic Plan

27. TB (all case) notification and death rates per 100,000 in South Australia 1900 and 2006
160
140
Death Rate
Notification Rate
120
100
3% decline
Notification Rate/100,000 80
The National TB 60
Campaign
improved 40
socioeconomic
10%
conditions 4% 20 8%
14%
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
2000
Year

28. The National TB Campaign Australia, 1948-1975
National Leadership (NTP)
Commitment from
National & State Govt
Funding
Legislative muscle – mandatory participation
The Health Professions
The community, because of
community concern
promotion of TB the disease and of the TB Campaign
Financial incentives for patients with active disease to adhere to treatment
A new Strategic Direction & sound systems, infrastructure
Adequate funding
Effective system of care
active disease and infection case finding, new drugs, centralised treatment
Adequate laboratory services
DOT?
Free drug supplies
Appropriate monitoring systems, for individual care and Program
No public/private mix, MDR-TB, HIV issues, but migration+

29. TB (all case) notification rate per 100,000 South Australia - 1945 to 2006 The National TB Campaign60 20 18 50 16 14 40 12
Notification Rate / 100,000 30
Target rate of decline 10% per year
Decline in Death Rate/ 100,000 10 8 20
Excess cases 6 4 10 2
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
Year
Death Rate
Target decline rate

30. TB notification rate by age, Australian-Born South Australians between 1987 - 2006
0<14
15<24
25<34
35<44
45<54
55<64
> 65 1 2 3 4 5 6 7 8 9
Notification Rate/100,000
Age

33. Elimination of TB as a public health problem
Framework of the Strategic Plan to Stop TB in the Western Pacific
VISION
Elimination of TB as a public health problem
To reduce prevalence and mortality from all forms of TB by one half by 2010 relative to 2000, contributing to the achievement of the Millennium Development Goals
GOAL

35. Framework of the Strategic Plan to Stop TB in the Western Pacific 2006 - 2010
1.To sustain
and optimize
the quality of
DOTS and go
beyond the
‘70/85’ targets
Case detection rate
(beyond 70%)
Cure rate
(beyond 85%)
2. To ensure
equitable
access to high
quality TB
care for all
people with TB
Proportion of
Facilities (include
private or general
hospitals) providing
or referring to DOTS
(at least 90%)
3. To adapt
DOTS to
respond to MDR
TB and TB-HIV
co infection
Proportion of
identified MDR-TB
cases by DST
provided with 2nd line
treatment
(at least 90%)
identified HIV
positive TB, eligible
for ART, that are
provided with ART
CORE TARGETS
Beyond 70% CDR
At least 90% DOTS-Plus Treatment coverage of
MDR-TB
OBJECTIVES
At least 90% ART coverage of HIV positive TB
At least 90% PPMD coverage

37. Framework of the Strategic Plan to Stop TB in the Western Pacific 2006 - 2010
Country capacity quality of diagnosis for TB assured (i.e. smear microscopy, culture, chest X-ray)
At least 90% laboratory units with satisfactory performance
Improved TB case
management in non-
NTP TB facilities
At least 85% cure rate of
TB cases managed by non-
NTP facilities
Assessment of MDR-TB
in targeted countries
All targeted countries
Have assessed their MDR-TB
situation through drug resistance
surveillance
Adoption of the
International Standards of
TB Care & the Patients
Charter for TB Care
All countries have introduced
the above standards
DOTS-Plus initiated/scaled up
in targeted countries
At least 6 have initiated/scaled up
DOTS-Plus. At least 10%0f failure
cases tested by DST
Uninterrupted supply of quality-assured anti-TB drugs at all DOTS units
100% of treatment units with uninterrupted supply
of drugs in a given year
EXPECTED
RESULTS
TB-HIV framework for
collaboration developed & implemented
All targeted countries are
implementing TB-HIV surveillance
Increased utilization of TB
services by poor &
vulnerable populations
At least 10% of cases notified
under pro-poor TB initiatives
Enhanced case
management for all
registered TB cases,
including smear
negative TB
All HBC have developed
guidelines for diagnosis
& treatment of smear
negative TB e.g. children
Country-driven advocacy,
communications & social
mobilisation strategies
developed & implemented
All HBC are implementing
ACSM strategies for TB control
on a national scale
Access of TB patients to HIV
Services
At least 70% of TB patients tested
for HIV in Category 1 and 2
countries/areas. At least 70% of
newly diagnosed patients with HIV
tested for TB

39. Components of the Strategic Plan & Implementation approaches
1. Pursue high quality DOTS expansion & enhancement
Political commitment with increased & sustained financing
Case detection through quality assured bacteriology
Standardised treatment with supervision & patient support
An effective drug supply & management system
Monitoring & evaluation system & impact measurement

40. Components of the Strategic Plan & Implementation approaches
2. Address TB-HIV, MDR-TB & other challenges
Implement collaborative TB-HIV activities
Prevent & control MDR-TB
Address prisoners, refugees & other high-risk groups
3. Contribute to health system strengthening
Actively participate in efforts to improve policy, human resources, financing, management service delivery & information systems
Share innovations, including the Practical Approach to Lung Health (PAL)
Adapt innovations from other fields

41. Components of the Strategic Plan & Implementation approaches
4. Engage all care providers
a. Public-Public & Public-Private Mix approaches
b. International Standards for TB Care (ISTC)
5. Empower people with TB & communities
Advocacy, communications & social mobilisation
Community participation in TB care
Patients Charter for TB Care
6. Enable & promote research
Program- based operational research
Research to develop new drugs, vaccines & diagnostics

42. Framework of the Strategic Plan to Stop TB in the Western Pacific 2006 - 2010
Activities directed at producing expected results are to be implemented at inter-country, regional and country levels:
- Inter-country and regional activities are in the WHO plans of action
- Country level activities are in the National TB Control Plans
ACTIVITIES
1. Ensured availability of essential staff required for TB control
90% of key positions required for TB control filled by trained staff
2. Sufficient financing for TB control ensured
All HBC develop annual funding plan for NTP that incorporates all financial inputs
and funding gaps
3. Evidence-based policy and implementation strategy development through operations research (e.g. PAL, information system, child TB, and new diagnostic modalities)
CROSS-CUTTING ISSUES

43. Estimated TB incidence rate, 2005
Estimated new TB cases (all forms) per population
No estimate
0-24
25-49
50-99
300 or more
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

44. What have we learned from the presentations?
The current burden of disease remains large
There are important Regional and Country successes
Some targets are being achieved but
The targets and so strategic plans are needing to be revised to achieve the primary Goal
There are significant barriers
Do we have systems in place to achieve these targets and overcome the barriers?

45. What else can/should we need to do?
What more should we (jointly) do – as the Union, the APR IUATLD, WHO, APSR & the many other organizations and as individuals?
What is the real view of our Communities and Governments about TB - what is the image of TB?
What can this and our future Conferences and its participants contribute to furthering the objectives of the Region?
What are the special skills and the special ‘Capital’ that the attendees and their organisations bring?

46. The Future Direction The vision ‘The elimination of TB’ is right
The objectives are right.
It needs global and local leadership
It needs the proper application of our knowledge
The resolve must be strengthened
All cases have to be found and treated
New drugs must be found
More resources are needed
TB can be eliminated.

47. It can be
and
it has to be done

48. My Thanks To: The Congress President The Secretariat
The Chair of the Organizing Committee
The Chair of the Organizing Scientific Committee
The Speakers
and …. to all of you who have attended and participated

49. Dr Ral Antic Chair, Scientific Committee IUATLD-APR Australia
Tuberculosis Control in the Asia Pacific Region   
Achievements, Deficiencies & Future Directions 
Dr Ral Antic
Chair, Scientific Committee IUATLD-APR
Australia

50. What is the role of APR IUATLD?
Workforce
Training
Advocacy
Service provision

51. What is the APR IUATLD The Asian Pacific Region of the UNION
In 2006, the Eastern Region IUATLD was divided into 2 new Regions, the South East Asian and Asian Pacific
The aim was to reduce the size of the Regions to help facilitate their TB work
There are 16 APR constituent member countries and other organisations and individuals

52. The different & complementary roles
Global and regional organisations
Organisations within each country
Governments
Government and non-Government Organisations
Different countries
Within countries

53. Functional relationships
Organisations responsible for different diseases with overlapping risk factors and populations
e.g. malaria, TB, AIDS

54. The challenges and barriers 1
The Private Sector
NTP does not cover private sectors. Detailed information on case-finding activities & treatment outcomes are not known yet. The pilot project of Private-public mix (PPM) just started this year on a small scale with collaboration from some of university hospitals
NTP has a plan to make guidelines for PPM
The issues and challenges relate to improving the quality of reporting and treatment activities within the private sector
How to increase the level of access of illegal foreign workers to medical facilities
Case Finding and associated delays
How to strengthen the capabilities of health workers in conducting contact investigation of TB outbreaks

55. The barriers 1 Laboratories
Challenge is to integrate commercial laboratories into the laboratory network of NTP and to expand quality assurance system
Coordination & collaboration between TB, HIV, Malaria programs
High burden and mortality of HIV among TB patients and TB among HIV-infected persons, and the high mortality rate of TB/HIV patients, successful TB/HIV collaboration is essential.
The political commitment has been critical for initiating the collaboration between programs
The support from technical and financial partners has facilitated the implementation of the collaborative activities

56. The barriers 2
This largely entails the sustenance of quality D.O.T.S. implementation and undertaking this in the context of health sector reforms and globalization. DOTS and DOTS beyond is our way forward. (Phil)
The challenges including: ( chin)
Migrants, MDR-TB, TB/HIV
Quality of DOTS implementation to be improved
Mechanism to ensure sustainability
Inadequate human resource
Adequacy of infrastructure
Adequate funding of Programs
Surveillance
Health promotion
Strengthen human resource development
Lack of resources to tackle new challenges

57. Future Directions
The global community needs to continue to take responsibility and make world-wide TB control a high priority

58. Strategic Plan to Stop TB in the Western Pacific 2006-2010
A Road Map
Ensure quality of TB Services
Respond to challenge of rising MDRTB, TB-HIV co-infection
Increasing case detection rate
To get public and private health sector involved in TB control
Increasing funding and regional and country level

59. Prisons
Correctional institutions
Social sponsored centers
Development of a TB like Unit
Cooperation and coordination of NTP, NTP/HIV, Ministry of Health, Ministry of Labor, War Invalids and Social Welfare and Ministry of Public Security
Sustain political interest, training guidelines, advocacy and incentives, monitoring and supervision

60. Financing TB Control
Although the funds available for TB control have increased enormously
since 2002 ($2.0 billion US in 2007). Interventions on the scale
required by the Global Plan to Stop TB would cost an extra $1.1 billion
US in 2007
The Global Plan is more costly than country budgets primarily because it anticipates greater TB/HIV requirements:
management, advocacy, communication & social mobilisation, especially in the African and South-East Asia regions
Greater expenditure was associated with improved case-finding in Bangladesh, China, Congo, India, Indonesia, Kenya, Myanmar & Nigeria
There was no systematic relationship between incremental expenditure and improved case detection across all HBCs
The relationship between spending and case-finding needs to be investigated and understood country by country.

61. DOTS and the Stop TB Strategy
Most government health services now recognise that TB control must go beyond DOTS, but the broader Stop TB
Strategy is not yet fully operational in most countries

62. Future Directions
Countries and regions are more likely to reach these targets if they can increase budgets and step up activities in line with the Global Plan.
Procedures for collecting financial and epidemiological data, and other information about programme performance, must be systematically improved.
Surveillance and monitoring, and well-designed surveys, are a prerequisite for the accurate evaluation of progress in TB control.

63. The STOP TB STRATEGY The Objectives
To achieve universal access to high quality diagnosis and patient centered treatment
To reduce the suffering and socioeconomic burden associated with TB
To protect poor and vulnerable populations from TB, TB-HIV and MDR-TB
To support development of new tools and enable their timely and effective use

64. To address high case fatality rates, it is necessary
HIV-TB IN THE WESTERN PACIFIC REGION PROGRESS OF TB/HIV COINFECTION CONTROL IN CHINA DR. PHILIPPE GLAZIOU Y.J.LAI*, S.W.JIANG*,W.B. YU**, L.ZHOU*, *National Center for TB Control and Prevention, China CDC, China **Tuberculosis Office of China Global Fund Program
To address high case fatality rates, it is necessary
to rapidly step-up the implementation of;
provider-initiated HIV testing
systematic detection of TB in HIV-infected individuals including diagnosis of the smear negative forms of TB
infection control in AIDS care settings
adequate treatment and support of dually infected individuals, including anti-retroviral therapy during the course of TB treatment

65. Early benefit but long term protection is uncertain
LATENT TB INFECTION IN HIV: TO TREAT OR NOT TO TREAT ? NITIPATANA CHIERAKUL
Early benefit but long term protection is uncertain

66. AGING OF TB EPIDEMIC, CASE OF JAPAN DR. TAKASHI YOSHIYAMA
As community wide burden is reduced, the high prevalence in the aged becomes more noticeable
The previously infected population is living longer
In countries where transmission of infection has been low, the numbers in the aged population is falling.
The case fatality rate of older tuberculosis cases is high and WHO target of 85% treatment success is difficult to achieve

67. TRADITIONAL AND NOVEL DIAGNOSTIC TESTS FOR TB INFECTION TORU MORI
TST opened the way to the modern epidemiology of TB decades ago.
The diagnosis TB infection is important both in high and low-prevalence settings for epidemiological surveillance and research, indication for treatment of latent TB infection, an adjunct for diagnosis of active TB, etc.
The new technology, Interferon-gamma release assay (IGRA), has been tested extensively, and it seems that it is practically as sensitive as TST and far exceeds its specificity. Other aspects of its performance, including influence of immunocompromizing factors, effects of treatment (both in active disease and latent TB infection), and cost-effectiveness have gradually been clarified.

68. Posing a threat to TB Control in several countries in WPR
MDR-TB: DISEASE IN THE WPR DR. PHILIPPE GLAZIOUDRUG SUSCEPTIBILITY TESTS FOR FIRST & SECOND LINE DRUGS IN DIAGNOSIS OF MDR & XDR TUBERCULOSIS DR CAMILLA RODRIGUES, MD NEW DRUGS AND DRUG REGIMENS IN THE TREATMENT OF CHRONIC AND MDR-TB W.W. Yew
Posing a threat to TB Control in several countries in WPR
Special programs may be required to reduce its increasing prevalence
Improved interventions under DOTS
Programmatic management MDR-TB
urgent need to strengthen capacity for prompt and accurate laboratory based diagnosis of tuberculosis and detection of drug resistance
strengthening of DOTS and DOTS-Plus programmes, infection control, and information sharing to enable local and global control
Development of new drugs is a mandatory focus of activity too.

69. THE SINGAPORE TB ELIMINATION PROGRAMME (STEP) DR CYNTHIA CHEE
Reduction in prevalence via STEP program

70. Changes in policy, attitudes and resources needed
TB-HIV TREATMENT IN A PRISON SETTING DR. BENEDICT SIM LIM HENG TUBERCULOSIS (TB)- HUMAN IMMUNODEFICIENCY VIRUS (HIV) SCREENING PROGRAMME IN CLOSED SETTINGS B. VENUGOPALAN (MPH) Disease Control Unit, Selangor State Health Department, Ministry of Health, Malaysia.
Many barriers to TB control, institutional, high burden of TB/HIV on entry, staff morale, drug availability and delivery etc
In 1993, WHO presented their guidelines on HIV infection and AIDS in prisons and the 1st guiding principle in that article quoted was that “All prisoners have the right to receive health care, including preventive measures, equivalent to that available in the community without discrimination, in particular with respect to their legal status or nationality.”
Changes in policy, attitudes and resources needed

71. What are we trying to achieve?
Millennium Development Goals
Stop TB Partnership targets

72. Dr Ral Antic Chair Scientific Committee IUATLD-APR Australia
Pre-Conference Workshop 1
National TB Control Program  
Summary & Remarks
Dr Ral Antic
Chair Scientific Committee IUATLD-APR
Australia

73. TB Control in WPR-current state
We have heard reports from a mix of High, Intermediate and Low burden countries
Significant improvements in reported results
WHO targets are reported to be overall being met
Yet ongoing burden of disease is often reported as high and trend of morbidity and mortality is ‘stagnant’
Ageing population and access to illegal migrants
HIV-TB co-infection
MDR-TB levels rising in some countries
The performance of the private sector and general hospitals is variable
Concern re care in the poor and vulnerable populations
Health sector infrastructure variable especially in districts
Funding and health workforce, although improved remains an issue

74. TB Performance Indicators in the Western Pacific Region, 2004
“Strategic Plan to Stop TB in the Western Pacific 2006 – 2010”
Prevalance Rate (/105)
Case detection
SS+ (%)
Treatment Success (%)
Mortality Rate (/105)
Australia 6 56 95 1
Cambodia
709 61 93 94
China
221 65 17
Hong Kong 77 72 78
Japan 39 62 76 4
Lao PDR
318 55 79 25
Malaysia
133 69 16
Mongolia
209 80 87 24
New Zealand 11 59 36
Papua New Guinea
448 31 58 42
Philippines
463 73 88 48
Republic of Korea
125 82 10
Singapore 41 67
Vietnam
232 89 92 22
TB Performance Indicators in the South East Asia Region, 2004
“National Tuberculosis Control Programs South East Asia Region”
Indonesia
262 66 90
Thailand
218 74 20

75. Estimated WPR Burden from TB and Trends
Estimated 4 million cases of TB in WPR
2 million new cases
Seven high burden countries account for >95%
Cambodia, China, Lao PDR, Mongolia, PNG, Philippines & Vietnam
A decline of 15% in prevalence & 12% in mortality between
Annual average of 4% and 3% respectively

76. ACHIEVEMENTS In Leadership terms In Strategic Planning
Implementation Strategy
Activities
Infrastructure building
Surveillance and Quality monitoring

77. Incentives Direct To the health care providers To the person with TB
To the community
Indirect?

78. WP Regional Goals & Targets Regional Committee WPR, 2000
Reduce TB prevalence and mortality by 50% in 2010 compared with 2000
Intermediate Targets (towards this goal):
Detect 70% of estimated active cases
Treat successfully 85% of these cases
100% DOTS coverage

79. Case Detection in WPR From < 40% to >70% overall in 5 years
Achieved by:
Developing a strategic approach, The Global Plan to Stop TB
Strengthening political commitment
Accelerating DOTS expansion in public facilities
Higher case detection success in many countries
TB care more available and accessible
Improving collaboration of health providers
Increase in financing and other resources

80. Treatment Success
Overall the percentage of registered new TB patients completing anti TB treatment > 85% for last 10 years
5 of the 7 high burden of TB countries are achieving this target

81. Estimated numbers of new cases, 2005
Estimated number of new TB cases (all forms)
No estimate
0-999
or more
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

82. Will achieving WHO targets reduce the notification rate?
The barriers
Spread of HIV
Accumulation of MDR-TB cases
Insufficient access to high quality TB care for the poor and vulnerable populations
Sub-optimal TB management practices in growing private sector
Lack of National guidelines & training materials
Lack of human resources and their development
AND/OR
the rising population numbers
Incorrect targets for the desired outcome

83. Future Directions
The current level of detection of 70% will not be sufficient
Enhancing active case finding approaches
Enhancing lab capacity
New diagnostic tools
Sustaining established mechanisms - e.g. monitoring and supervision of DOTS implementation
MDR-TB and TB-HIV co-infection will slow the annual decline
Conventional DOTS service delivery does not guarantee equitable access to TB Services
In some countries, the same standards of care received through NTP service delivery are not met by general hospitals, private providers, and for the homeless, drug users, migrants & prisoners

85. What have we learned from these presentations?
The current burden of disease remains large
There are important Regional and Country successes
Some targets are being achieved but
The targets have needed to be revised to achieve the objects
There are significant barriers
Do we have systems in place to achieve these targets?

86. Dr Ral Antic Chair Scientific Committee IUATLD-APR Australia
Pre-Conference Workshop 1
National TB Control Program  
Concluding remarks for the Workshop
Dr Ral Antic
Chair Scientific Committee IUATLD-APR
Australia

87. Barriers to success Rising MDR-TB Rising TB & HIV Co-infection
Access to poor & vulnerable populations
Prisons,homeless
Aging population
Suboptimal health infrastructure
Lack of health workers
Suboptimal laboratory facilities

88. ‘Programmatic’ factors
Accessibility of treatment services
Awareness of TB in the community
Uninterrupted supply of effective TB drugs
Treatment adherence through DOTS

89. Will achieving WHO targets reduce the notification rate?
The barriers
Spread of HIV
Accumulation of MDR-TB cases
Insufficient access to high quality TB care for the poor and vulnerable populations and private sector
Lack of National guidelines & training materials
Lack of human resources and their development
AND/OR
the rising population numbers
Incorrect targets for the desired outcome

90. The 3 main areas to be addressed
The current level of 70% detection will not be sufficient
MDR-TB and TB-HIV co-infection will slow the annual decline
Conventional DOTS service delivery does not guarantee equitable access to TB Services

91. The new Strategic Plan for WPR 2006-2010
To achieve the 50% reduction in prevalence & death, an 8% annual decline is needed
The current annual decline is 3%
There thus needs to be a change in approach
This is the basis of the strengthened effort defined in the new Strategic Plan

93. Reasons for significant improvements in TB Control
The rapid expansion of DOTS after WHO declared a global TB crisis in 1993
Higher case detection and treatment success in many countries
The Stop TB Partnership, est in 2000,
The Global Plans to Stop TB
The significant increase in resources for TB
TB care more available and accessible

94. Will achieving WHO targets improve notification rate?
The barriers
Spread of HIV
Accumulation of MDR-TB cases
Insufficient access to high quality TB care for the poor and vulnerable populations
Sub-optimal TB management practices in growing private sector
Lack of National guidelines & training materials
Lack of human resources and their development

97. Tuberculosis notification rates, 2005
Notified TB cases (new and relapse) per population
No report
0-24
25-49
50-99
100 or more
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98. TB Notification rate by population group for South Australia, 2006
0<14
15<24
25<34
35<44
45<54
55<64
>65
Overseas Born
Australian Born
Indigenous 5 10 15 20 25 30 35
Notification Rate/100,000
Age