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

2. TB Control in WPR-current state 1.We have heard reports from a mix of High, Intermediate and Low burden countries 2.Significant improvements in reported results 3.WHO targets are reported to be overall being met 4.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

3. TB Performance Indicators in the Western Pacific Region, 2004 “Strategic Plan to Stop TB in the Western Pacific 2006 – 2010” Prevalance Rate (/10 5 ) Case detection SS+ (%) Treatment Success (%) Mortality Rate (/10 5 ) Australia656951 Cambodia709619394 China221659417 Hong Kong7772786 Japan3962764 Lao PDR318557925 Malaysia133697216 Mongolia209808724 New Zealand1159361 Papua New Guinea448315842 Philippines463738848 Republic of Korea125598210 Singapore4167774 Vietnam232899222 TB Performance Indicators in the South East Asia Region, 2004 “National Tuberculosis Control Programs South East Asia Region” Prevalance Rate (/10 5 ) Case detection SS+ (%) Treatment Success (%) Mortality Rate (/10 5 ) Indonesia262669041 Thailand218737420

4. 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 2000-2004 –Annual average of 4% and 3% respectively

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

6. WP Regional Goals & Targets Regional Committee WPR, 2000 Goal: Reduce TB prevalence and mortality by 50% in 2010 compared with 2000 Intermediate Targets (towards this goal): 1.Detect 70% of estimated active cases 2.Treat successfully 85% of these cases 3.100% DOTS coverage

7. Case Detection in WPR From 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

8. 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

9. Estimated numbers of new cases, 2005 No estimate 0-999 10 000-99 999 100 000- 999 999 1 000 000 or more 1000-9999 Estimated number of new TB cases (all forms) 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 2006. All rights reserved

10. 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

11. 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

12. 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?

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