Global Tuberculosis Report -- 2012.pdf

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BOX 7.1Accelerating progress in providing ART to TB patients living with HIVPeople with HIV-associated TB have a high risk of mortality. For example, in autopsy studies of people who were HIV-positive, TB wasidentifi ed in 30–79%. 1,2 Expanding access to ART will have a signifi cant impact on mortality among HIV-positive TB patients, in additionto reducing the risk of developing TB among people living with HIV who do not have active TB.Since 2010, WHO has recommended ART for TB patients regardless of CD4 cell-count. Furthermore, the optimum time to start ART inpatients with HIV-associated TB has now been established in three large randomized controlled trials. 3,4,5 These studies collectivelyshowed that ART should be given concurrently with TB treatment regardless of CD4 cell-count. The risk of AIDS and death in those withprofound immunosuppression (CD4 cell-count
FIGURE 7.7Number of people screened (millions)43210FIGURE 7.8Number of HIV-positive people without active TB(thousands)5004003002001000FIGURE 7.9Number of lives saved (millions)0.50.40.30.20.1Intensified TB case-finding among peopleliving with HIV, 2005–20112005 2006 2007 2008 2009 2010 2011Provision of isoniazid preventive therapy(IPT) to people living with HIV withoutactive TB, 2005–20112005 2006 2007 2008 2009 2010 2011Estimated number of lives saved globally bythe implementation of TB/HIV interventions,2005–2011. The blue band represents theuncertainty interval.2005 2006 2007 2008 2009 2010 2011compared with 2.3 million in 71 countries in 2010 (Figure7.7). Unfortunately, at the time this report went to press,the total number of people enrolled in HIV care in 2011was not available (the figure was 4.0 million in 2010).Nonetheless, it is clear that further progress is needed toapproach the target in the <strong>Global</strong> Plan, which is to screenall those enrolled in HIV care for TB by 2015.Among 29 countries that reported data, IPT was providedto almost 450 000 people living with HIV in 2011,more than double the 201 000 people provided with IPT in2010 (Figure 7.8). Most of the increase occurred in SouthAfrica, where 373 000 people were reported to have beenprovided with IPT in 2011, followed by Ethiopia (31 000),Mozambique (17 000) and Namibia (14 000). Unfortunately,at the time this report went to press, the totalnumber of people newly enrolled in HIV care in 2011 andpotentially eligible for IPT was not available (the figurewas 1.5 million in 2010). However, as with TB screeningamong people in HIV care, it is clear that further effortsare needed to reach the <strong>Global</strong> Plan’s 2015 target of providingIPT to all those eligible for it – estimated at approximately50% of those newly enrolled in HIV care.7.4 Lives saved by the implementationof collaborative TB/HIV activities,2005–2011In the years between the publication of WHO’s first policyon collaborative TB/HIV activities in 2004 and updatedguidance launched in 2012, 1,2 considerable progress inimplementing the recommended package of interventionsoccurred, as documented in Section 7.1, Section 7.2and Section 7.3. At the time that updated guidance waspublished in March 2012, the lives saved as a result ofthe implementation of collaborative TB/HIV activitiesbetween 2005 and 2010 were estimated. Here, the analysisis extended to 2011 and methods are explained.Four interventions were considered:● ART provided during TB treatment for people livingwith HIV;● CPT provided during TB treatment for people livingwith HIV;● IPT for HIV-positive people enrolled in HIV care;● Early TB diagnosis through systematic screening forTB among people living with HIV.These interventions were compared with a counterfactualscenario defined as no ART, no CPT, no IPT and no TBscreening.1Policy on collaborative TB/HIV activities. Geneva, World HealthOrganization, 2004 (WHO/HTM/TB/2004.330; WHO/HTM/HIV/2004.1).2WHO policy on collaborative TB/HIV activities: guidelines for nationalprogrammes and other stakeholders. Geneva, 2012 (WHO/HTM/TB/2012.1).80 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
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● producing and widely disseminat
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FIGURE 2.16 Progress in global cove
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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
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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
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Page 86 and 87: FIGURE 7.3Percentage of TB patients
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
Page 132 and 133: SOUTH AFRICAPopulation 2011 50 mill
Page 134 and 135: UGANDAPopulation 2011 35 millionHIG
Page 136 and 137: 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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