Global Tuberculosis Report -- 2012.pdf

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FIGURE 6.3The Supranational Reference Laboratory NetworkMassachusetts, USAAtlanta, USAMexico City, MexicoBilthoven, NetherlandsAntwerp, BelgiumLondon, UKGauting, GermanyMilan, ItalyPorto, PortugalBarcelona, SpainLe Hamma, AlgeriaCopenhagen, DenmarkStockholm, SwedenRiga, LatviaBorstel, GermanyPrague, Czech RepublicZagreb, CroatiaRome, ItalyCairo, EgyptSeoul, Republic of Korea Tokyo, JapanKarachi, PakistanHong Kong, China SARGuadeloupe, FranceCotonou, BeninChennai, IndiaKampala, UgandaBangkok, ThailandSantiago, ChileBuenos Aires, ArgentinaPretoria, South AfricaAdelaide, AustraliaBrisbane, AustraliaSupranational Reference LaboratorySupranational Reference Laboratory Coordinating CenterCandidate Supranational Reference LaboratoryGLOBAL TUBERCULOSIS REPORT 2012 73
CHAPTER 7Addressing the co-epidemicsof TB and HIVKEY FACTS AND MESSAGES In 2011, 1.1 million (13%) of the 8.7 million people whodeveloped TB worldwide were HIV-positive; 79% ofthese HIV-positive TB cases were in the African Region. WHO’s recommended package of collaborative TB/HIV activities to reduce the burden of TB/HIV includesHIV testing for TB patients; CPT and early initiation ofART for HIV-positive TB patients; and screening for TBamong people living with HIV and provision of IPT tothose eligible for it. Substantial progress in the implementation ofcollaborative TB/HIV activities has occurred since WHOrecommendations were fi rst issued in 2004, and furtherprogress was evident in 2011. The percentage of notifi ed TB patients with adocumented HIV test result in the African Region rosefrom 60% in 2010 to 69% in 2011; 46% of thosetested in 2011 were HIV-positive, ranging from 8% inEthiopia to 77% in Swaziland. Worldwide, 40% of TBpatients notifi ed in 2011 had a documented HIV testresult, up from 33% in 2010 and more than ten timesthe level of 2004. In 2011, 79% of TB patients known to be HIV-positive,were provided with CPT, and 48% were started onART, similar to levels achieved in 2010. More workremains to be done to ensure that all HIV-positive TBpatients are rapidly started on ART, in line with WHOrecommendations. Their progress on treatment shouldalso be closely monitored. In 2011, 3.2 million people enrolled in HIV care werereported to have been screened for TB, up 39% from2.3 million in 2010. Of those without active TB disease,0.45 million were provided with IPT, more than doublethe number started on IPT in 2010 (mostly the result ofprogress in South Africa). The scale-up of collaborative TB/HIV activities saved atotal of 1.3 million lives between 2005 and the end of2011.People living with HIV who are also infected with TB aremuch more likely to develop TB disease than those whoare HIV-negative. 1 Starting in the 1980s, the HIV epidemicled to a major upsurge in TB cases and TB mortality inmany countries, which persisted throughout the 1990sand up to around 2004, especially in southern and eastAfrica (Chapter 2, Chapter 3).In 2011, 1.1 million (13%) of the 8.7 million peoplewho developed TB worldwide were HIV-positive (Chapter2, Table 2.1); 79% of these HIV-positive TB cases werein the African Region. <strong>Global</strong>ly, there were an estimated0.4 million HIV-associated TB deaths in 2011, withapproximately equal numbers among men and women(see Chapter 2). WHO, UNAIDS and the Stop TB Partnershiphave set a target of halving TB mortality ratesamong people who are HIV-positive by 2015 comparedwith 2004 (the year in which TB mortality among HIVpositivepeople is estimated to have peaked). 2WHO recommendations on the interventions neededto prevent, diagnose and treat TB in people living withHIV have been available since 2004, 3,4 and are collectivelyknown as collaborative TB/HIV activities. They includetesting TB patients for HIV, providing antiretroviral therapy(ART) and co-trimoxazole preventive therapy (CPT)to TB patients living with HIV, providing HIV preventionservices for TB patients, intensifying TB case-findingamong people living with HIV, offering isoniazid preventivetherapy (IPT) to people living with HIV who do nothave active TB, and controlling the spread of TB infectionin health-care and congregate settings (the latter threeactivities are referred to as the “Three Is for HIV/TB”).Antiretroviral therapy significantly reduces the risk ofmorbidity and mortality from TB. A meta-analysis publishedin 2012 found that ART reduces the individual risk1The probability of developing TB among people living withHIV divided by the probability of developing TB among HIVnegativepeople is the incidence rate ratio (IRR). The medianvalue of the IRR in 155 countries for which data were availablein 2011 was 14 (inter-quartile range 12–20).2Getting to zero: 2011–2015 strategy. Geneva, Joint United NationsProgramme on HIV/AIDS, 2010.3Policy on collaborative TB/HIV activities. Geneva, World HealthOrganization, 2004 (WHO/HTM/TB/2004.330; WHO/HTM/HIV/2004.1).4WHO policy on collaborative TB/HIV activities: guidelines for nationalprogrammes and other stakeholders. Geneva, 2012 (WHO/HTM/TB/2012.1).74 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
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FIGURE 2.5 Estimated TB incidence r
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FIGURE B2.2.1Reporting of notificat
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FIGURE 2.8Estimated TB incidence ra
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FIGURE 2.11 Countries (in blue) for
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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 72 and 73: FIGURE 5.10 Total cost and unit cos
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 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
Page 122 and 123: ETHIOPIAPopulation 2011 85 millionH
Page 124 and 125: INDONESIAPopulation 2011 242 millio
Page 126 and 127: MOZAMBIQUEPopulation 2011 24 millio
Page 128 and 129: NIGERIAPopulation 2011 162 millionH
Page 130 and 131: 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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