1. 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

2. 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

3. 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

4. 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

5. 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. 

6. 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

7. 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

8. 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

9. We have political commitment from national governments

10. 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

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