Global Tuberculosis Report -- 2012.pdf

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FIGURE 5.10 Total cost and unit cost of first- and second-line anti-TB drugs in 99 countries, a 2009–2013, bby income groupTotal cost, US$ millions(constant 2012 US$)Upper middle-income countries excluding RS c1005754 605028 272202009 2010 2011 2012 2013Lower middle-income countries10281706434212009 2010 2011 2012 2013Low-income countries4631445 4 132009 2010 2011 2012 2013First-line,5–95thpercentilesSecond-line,5–95thpercentilesUpper middle-income countries excluding RS c 2009 2010 2011 2012 2013Lower middle-income countriesLow-income countriesUnit cost, (constant US$), log scale2000010000 724750001000383510047 47503046725044532320 439626 28232022291199 256036362009 2010 2011 2012 20132009 2010 2011 2012 2013aThese 99 countries account for 85% of global drug-susceptible TB cases and 29% of MDR-TB cases receiving treatment. See also note (c).bValues for 2012 and 2013 are based on country plans and budgets, not actual expenditures. Unit costs are case-weighted two-year averages to adjust for purchases ofbuffer stock.cThe Russian Federation (R) and South Africa (S) were excluded as they did not report expenditures for 2011 or funding expected for 2012–2013. Together, they account forabout 9% of global drug-susceptible TB cases and 45% of MDR-TB cases receiving treatment.FIGURE 5.11 Funding gaps for TB care and controlas reported by countries, by line item,2006–2013US$ millions (constant 2012 US$)8006004002000-1003225544866025145676597092006 2007 2008 2009 2010 2011 2012 2013OtherACSM/CBC/PPM/PAL/OR/surveysTB/HIVMDR-TBDOTS, excludingfirst-line drugsDOTS, first-linedrugsLine item surplus aaFunding available for a given line item may exceed that required for the sameline item under a country’s plan and budget.TABLE 5.3 Summary of funding requirements for TBcontrol during the period 2011–2015, as set outin the Global Plan to Stop TBPLAN COMPONENTTOTAL FUNDING REQUIRED(US$ BILLIONS) [% OF TOTAL]PLAUSIBLERANGEImplementation 36.9 [79%] 36.1–37.7DOTS 22.6 [48%] 22.1–23.2MDR-TB 7.1 [15%] 6.6–7.7TB/HIV 2.8 [6%] 2.7–2.9Laboratory strengthening 4.0 [8%] 3.7–4.2Technical assistance 0.4 [1%]Research and development 9.8 [21%]Fundamental research 2.1 [5%]New diagnostics 1.7 [4%] not estimatedNew drugs 3.7 [8%]New vaccines 1.9 [4%]Operational research 0.4 [1%]All components 46.7 [100%] 45.9–47.5GLOBAL TUBERCULOSIS REPORT 2012 63
FIGURE 5.12 Funding required for DOTS and MDR-TBin the Global Plan 2011-2015 comparedwith projections of potential funding fromdomestic sources, for six country groupsUS$ billions (current)BRCS a4.03.02.01.00Other HBCs1.00.80.60.40.20Low-income countries0.80.60.40.20aBrazil, Russian Federation, China and South Africa (BRICS excluding India)bThe seven countries included in this group are Armenia, Georgia, Kyrgyzstan,Republic of Moldova, Tajikistan, Ukraine and Uzbekistan. Of the fundingavailable in 2012, approximately half is accounted for by Ukraine. The countriesin this group continue to hospitalize TB patients for lengthy periods of time,while in the Global Plan it was assumed that reliance on inpatient hospital carein the European Region would be progressively reduced between 2006 and 2015to an average of 60 days per patient with drug-susceptible TB by 2015. Thisexplains why the funding amounts estimated to be needed in the Global Plan arelower than the funding available in this group of countries.cAssumes that: 1) international donor funding received by BRICS in 2011 issubstituted by domestic sources; and 2) domestic funding for TB care and controlin all low and middle-income countries will keep pace with IMF forecasts ofgrowth in GDP per capita.0.50.40.30.20.100.60.40.200.30.20.10IndiaSeven other low- and middle-incomeEuropean countries with a high burdenof MDR-TB bLow-income countries excluding HBCs2011 2012 2013 2014 2015 2011 2012 2013 2014 2015Funding required for DOTS and MDR−TBFunding required for DOTSFunding required for MDR−TBFunding forecast to be available from domestic sources ctreatment of MDR-TB, for which the funding requirementwas estimated at US$ 1 billion in 2011, rising toUS$ 1.9 billion in 2015. The funding required for collaborativeTB/HIV activities (see Chapter 7) increases to aboutUS$ 1 billion by 2015, mostly (about 90% of the total) forantiretroviral therapy for HIV-positive TB patients thatwould be funded via HIV programmes (not NTPs).The funding requirements set out in the Global Planare considerably more than the funding amounts reportedby countries. For example, the funding required in 2015according to the Global Plan is about US$ 2 billion morethan the funding reported to be available in 2013. 1 In thiscontext – and with international funding constrainedby economic stagnation or recession in traditional donorcountries – assessing the funding that can be mobilizedfrom domestic sources is of increasing importance.Figure 5.12 shows estimates of the funding required fortreatment of TB and MDR-TB in the Global Plan, and forselected groupings of countries defined by their TB burdenand income level. Amounts for collaborative TB/HIVactivities are deliberately excluded because ART, the mainintervention in terms of cost, is not funded through NTPs.It is therefore not appropriate to compare funding needsfor collaborative TB/HIV activities with funding reportedby NTPs. Also shown in Figure 5.12 are projections of thefunding that could be mobilized from domestic sources ineach country group, on the assumption that: (i) internationaldonor funding received by BRICS in 2011 is substitutedby domestic sources; and (ii) domestic allocationsfor TB care and control in all low- and middle-incomecountries will keep pace with IMF forecasts of growth inGDP per capita.The data shown in Figure 5.12 provide insights thatcould inform future discussions about investments in TBcare and control, including prioritization of donor fundingamong countries and interventions and targets forresource mobilization. For example:● There is domestic capacity to fund the investmentsneeded for basic TB care and control (DOTS) in BRICS.● An increase in domestic allocations for TB care andcontrol in line with forecast growth in GDP per capitawould be sufficient to mobilize the funding needed fordiagnosis and treatment of MDR-TB in Brazil, the RussianFederation, China and South Africa (all of whichare upper middle-income countries).● In India, without growth in domestic allocations forTB above forecast growth in GDP per capita, aboutUS$ 0.1 billion per year is needed from donor sources.1This is excluding amounts for TB/HIV that are mostly for ARTfunded through HIV programmes, and allowing for fundingin the 34 countries considered in the Global Plan that are notin the group of 115 countries for which data were available for2011 or 2012 (Table 5.1). It is anticipated that most of the fundingfor TB/HIV interventions will need to come from internationaldonors.64 GLOBAL TUBERCULOSIS REPORT 2012
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GLOBALTUBERCULOSISREPORT2012
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ContentsAbbreviationsivAcknowledgem
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AcknowledgementsThis report on glob
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WHO Western Pacific RegionShalala A
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Executive SummaryThe World Health O
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CHAPTER 1IntroductionBOX 1.1Basic f
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TABLE 1.1 Targets for the scale-up
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TABLE 1.2 Reporting of data in the
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BOX 2.1Uncertainty in estimates of
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TABLE 2.2 Estimated burden of disea
Page 22 and 23: FIGURE 2.5 Estimated TB incidence r
Page 24 and 25: FIGURE B2.2.1Reporting of notificat
Page 26 and 27: FIGURE 2.8Estimated TB incidence ra
Page 28 and 29: FIGURE 2.11 Countries (in blue) for
Page 30 and 31: FIGURE 2.12 Trends in estimated TB
Page 32 and 33: ● producing and widely disseminat
Page 34 and 35: FIGURE 2.16 Progress in global cove
Page 36 and 37: BOX 2.6Efforts by the Task Force to
Page 38 and 39: CHAPTER 3TB case notificationsand t
Page 40 and 41: BOX 3.1 1Definitions of TB casesDef
Page 42 and 43: TABLE 3.3 Contribution of public-pr
Page 44 and 45: BOX 3.4Integrating community-based
Page 46 and 47: TABLE 3.4 Estimates of the case det
Page 48 and 49: TABLE 3.5 Treatment success for new
Page 50 and 51: CHAPTER 4Drug-resistant TBKEY FACTS
Page 52 and 53: FIGURE 4.2 Percentage of new TB cas
Page 54 and 55: BOX 4.1Frequencies of resistance to
Page 56 and 57: FIGURE 4.6 Number of MDR-TB cases e
Page 58 and 59: FIGURE 4.7Notified cases of MDR-TB
Page 60 and 61: egimens globally, providing more su
Page 62 and 63: 5.1 Funding for TB care and control
Page 64 and 65: TABLE 5.2 NTP budgets, available fu
Page 66 and 67: FIGURE 5.5Trends in domestic and do
Page 68 and 69: FIGURE 5.6Domestic funding as a per
Page 70 and 71: FIGURE 5.8Cost per TB patient succe
Page 74 and 75: ● The 14 countries not included i
Page 76 and 77: on public health by an external Exp
Page 78 and 79: evised as a result of the introduct
Page 80 and 81: TABLE 6.2 Incorporation of WHO poli
Page 82 and 83: FIGURE 6.3The Supranational Referen
Page 84 and 85: of TB disease by 65%, irrespective
Page 86 and 87: FIGURE 7.3Percentage of TB patients
Page 88 and 89: BOX 7.1Accelerating progress in pro
Page 90 and 91: TABLE 7.2 Assumptions used to estim
Page 92 and 93: FIGURE 8.1 The development pipeline
Page 94 and 95: sputum specimens and TB isolates fr
Page 96 and 97: cal trial sites and building labora
Page 98: new TB vaccine candidate. A Phase I
Page 102 and 103: This annex explains the methods tha
Page 104 and 105: 2011. On average, 15 data points we
Page 106 and 107: may suffer from biases. These biase
Page 108 and 109: TABLE A1.3Parameter estimates used
Page 110 and 111: 5. Estimates of TB prevalence, 1990
Page 112: the Republic of Moldova, Romania, t
Page 116 and 117: AFGHANISTANPopulation 2011 32 milli
Page 118 and 119: BRAZILPopulation 2011 197 millionHI
Page 120 and 121: CHINAPopulation 2011 1 348 millionH
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ETHIOPIAPopulation 2011 85 millionH
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INDONESIAPopulation 2011 242 millio
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MOZAMBIQUEPopulation 2011 24 millio
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NIGERIAPopulation 2011 162 millionH
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PHILIPPINESPopulation 2011 95 milli
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SOUTH AFRICAPopulation 2011 50 mill
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UGANDAPopulation 2011 35 millionHIG
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VIET NAMPopulation 2011 89 millionH
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ANNEX 3Regional profiles
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WHO REGION OF THE AMERICASPopulatio
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WHO EUROPEAN REGIONPopulation 2011
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WHO WESTERN PACIFIC REGIONPopulatio
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SUMMARY BY WHO REGIONTable A4.1 Est
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MORTALITY (EXCLUDING HIV) PREVALENC
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NEW AND RELAPSENOTIFICATION RATE aY
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-% OF TB PATIENTS WITHKNOWN HIV STA
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AFRICAN REGIONTable A4.1 Estimates
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INCIDENCE (INCLUDING HIV) INCIDENCE
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NEW AND RELAPSENOTIFICATION RATE aY
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NEW AND RELAPSENOTIFICATION RATE a1
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TREATMENT SUCCESS (%) a1995-2010YEA
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YEARTOTALCONFIRMEDCASES OFMDR-TB aE
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MALEYEAR 0-14 15-24 25-34 35-44 45-
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REGION OF THE AMERICASTable A4.1 Es
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% OF COHORTTREATMENT SUCCESS (%) a1
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MALEFEMALEYEAR 0-14 15-24 25-34 35-
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EASTERN MEDITERRANEAN REGIONTable A
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EUROPEAN REGIONTable A4.1 Estimates
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SOUTH-EAST ASIA REGIONTable A4.1 Es
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SMEAR LABS % OF SMEARPER 100K LABS
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Estimates of mortality, prevalence
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YEARPOPULATION(MILLIONS)MORTALITY (
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YEARPOPULATION(MILLIONS)INCIDENCE (
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YEARPOPULATION(MILLIONS)INCIDENCE (
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SMEAR LABS % OF SMEARPER 100K LABS
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