1. An Overview of TB in SAARC Countries and Role of SAARC TB Centre in TB Control Dr Paras K Pokharel, Associate Professor Dept. of Community Medicine, BPKIHS & Dr Dirgha S Bam Director SAARC TB Centre

2. Global TB Burden 50% of Global TB Burden occurs in 5 countries of South East Asia: India, Indonesia, Bangladesh, Thailand, Myanmar

3. TB is the leading single infectious cause of death in South-East Asia Deaths from infectious agents in South-East Asia

5. TB is a disease of vulnerable populations, eg: poor women refugees prisoners Prevalence of TB in poor and non poor populations in developing countries

6. TB is a Leading Killer of Women Deaths among women

7. Tuberculosis and SAARC TB a Major Public Health Problem in South Asian Countries with 38% total Global TB Burden SAARC Global SAARC Global New TB Cases 2.5 million/year 8 million/year Deaths due to 0.6 million/year 2 million/year TB

8. Tuberculosis and SAARC TB a Major Public Health Problem in South Asian Countries with 38% total Global TB Burden è Population 1,300 million è Prevalence of Tuberculosis6 million è New Cases of TB per year2.5 million è Death per year0.6 million

9. Estimated TB Incidence New TB Cases Countries in Million Bangladesh0.30 Bhutan & Maldives0.01 India1.80 Nepal0.05 Pakistan0.26 Sri Lanka0.04

10. 22 countries: 80% global TB burden

11. TB in South Asia All countries India

12. Global HIV Epidemic 33.6 million people living with HIV 5.6 million new infections and 2.6 million deaths in 2000 10% of new cases under 15 years 40% of cases in women 16.3 million deaths since beginning of epidemic WHO/UNAIDS: AIDS Epidemic Update December 2000

13. Estimated No. of Adults and Children living with HIV/AIDS as of end 2000 Australia & New Zealand 12 000 Sub- Saharan Africa 23.3 million Latin America 1.3 million Caribbean 360 000 North America 920 000 North Africa& Middle East 220 000 Western Europe 520 000 Eastern Europe & Central Asia 360 000 East Asia & Pacific 530 000 South & South-East Asia 6 million Total: 33.6 million

14. Australia & New Zealand 500 Sub- Saharan Africa 3.8 million Latin America 150 000 Caribbean 57 000 North America 44 000 North Africa & Middle East 19000 Western Europe 30 000 Eastern Europe & Central Asia 95000 East Asia & Pacific 120000 South & South-East Asia 1.3 million Total: 5.6 million

15. Current HIV Situation High HIV prevalence: India, Myanmar and Thailand* Low HIV prevalence in women in antenatal clinics but relatively high among IDU: Nepal Low HIV prevalence: Bangladesh, Bhutan, Indonesia, Maldives and Sri Lanka No reported HIV: DPR Korea * HIV now declining

16. To Summarize... Majority of new HIV infections are now in developing world Epidemic in the SAARC Region is dynamic and still evolving Epidemic started in many countries among IDU; now predominantly heterosexual spread Intensity of risk behavior and vulnerability determine HIV spread

17. HIV in South Asia 3,617,50012,809Total  7,3 00117Sri Lanka  64,000147Pakistan  33,000383Nepal  <1005Maldives  3,500,00012,239India  <1001Bhutan  13,00017Bangladesh Routine Surveillance Estimated HIV infections Reported AIDS cases Country

18. Tuberculosis and HIV- the Deadly Duo TB is the most common life threatening condition associated with HIV infection With the rise in HIV infection, Tuberculosis is also increasing as in Africa. The same is likely to happen in Asia as well

19. TB and HIV/AIDS Alliance is the most serious threat to TB Control

20. HIV and TB Dual Infection ç17% of global burden of dual infection çHIV seroprevalence in TB patients, Mumbai: 1988 2% 1992/3 9% ç> 50% of AIDS patients have TB Bangladesh 9,761 Bhutan 37 India 1,795,532 Maldives 32 Nepal 11,973 Pakistan 24,451 Sri Lanka 1,644 Total 1,843,430

21. TB and HIV in South Asia: The Context çHigh levels of stigma of vulnerable groups and of people with HIV çRapid political, cultural, economic and social transitions çLow status of women çPoverty çLimited political commitment and recognition of epidemic çLack of trust between government and civil society çIncreasing mobility of population çMost health care provided by private sector çWidespread and indiscriminate availability of TB medicines

22. Consequences of HIV Infection on NTPs of SAARC Member Countries Consequences of HIV Infection on NTPs of SAARC Member Countries ç Increased Case Load  Over diagnosis of sputum smear negative pulmonary TB ç Under diagnosis of TB because of atypical X-ray presentations  Low cure rates  High case fatality rates during treatment ç High default rates because of adverse drug reactions ç Increased emergence of drug resistance