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:: FIG. 4.18 Estimated ART treatment coverage for HIV-positive TB cases (HIV-positive TB patients on ART as a percentage of the estimated incidence of HIV-positive TB) in 2015, 30 high TB/HIV burden countries, WHO regions and globally Namibia Kenya Uganda Swaziland South Africa Zimbabwe Malawi Botswana Ethiopia Zambia Cameroon India Thailand Mozambique Lesotho UR Tanzania China Brazil Myanmar Chad DR Congo Nigeria Ghana Papua New Guinea Guinea-Bissau Liberia Congo Indonesia Angola a Central African Republic a a No data Africa The Americas Western Pacific South-East Asia Europe Eastern Mediterranean Global 0 25 50 75 100 Treatment coverage (%) In contrast, there were nine high TB/HIV burden countries (Brazil, Chad, China, Congo, Ghana, Guinea-Bissau, Indonesia, Liberia, and Myanmar) in which less than 50% of HIV-positive TB patients were started on ART in 2015. ART treatment coverage for people with TB can also be assessed by comparing the number of HIV-positive TB patients on ART with the estimated number of HIV-positive incident TB cases (Fig. 4.18). This comparison reveals larger gaps. Globally in 2015, the number of HIV-positive TB patients on ART was 33% of the estimated global number of incident HIV-positive TB cases. There was considerable variation among the high TB/HIV burden countries and only four achieved ART coverage of more than 50% (Kenya, Namibia, Swaziland and Uganda). Improvements are needed in the detection of TB among HIV-positive people, the coverage of HIV testing among TB patients, and the enrolment of HIV-positive TB patients on ART. 4.2.3 Treatment coverage for MDR/RR-TB Trends in the number of patients enrolled on MDR-TB treatment globally and in the 30 high MDR-TB countries since 2009 are shown in Fig. 4.11 and Fig. 4.12. The number of people enrolled on treatment globally was 124 990 in 2015, an increase of 13% from 110 587 in 2014. There was a 14% increase in enrolments between 2014 and 2015 in the 30 high MDR-TB burden countries, with increments amounting to more than 1000 patients in China, India, the Philippines, the Russian Federation and Ukraine. Globally, the 124 990 patients starting second-line MDR-TB treatment in 2015 represented about 37% of the 340 000 MDR/RR-TB cases estimated to have existed among pulmonary TB patients notified in 2015 (Fig. 4.19), and 20% of the incidence estimate (Fig. 4.11). Five countries accounted for over 60% of the gap between enrolments on MDR-TB treatment in 2015 and the estimated number of incident MDR/RR-TB cases in 2015: China, India, Indonesia, Nigeria and the Russian Federation (Fig. 4.16b). The number of cases starting MDR-TB treatment in 2015 was equivalent to 95% of the 132 120 MDR/RR-TB patients notified in that year (Table 4.1). The ratio exceeded 90% in 19 high MDR-TB burden countries, and the WHO European and South-East Asian regions, and was lowest in the GLOBAL <strong>TUBERCULOSIS</strong> REPORT 2016 :: 75
:: FIG. 4.19 Estimated MDR/RR-TB treatment coverage for MDR/RR-TB (patients started on treatment for MDR-TB as a percentage of the estimated number of MDR/RR-TB cases among notified pulmonary TB cases) in 2015, 30 high MDR−TB burden countries, WHO regions and globally Kazakhstan South Africa Belarus Peru Ukraine Russian Federation Azerbaijan Republic of Moldova Tajikistan Kyrgyzstan Viet Nam Zimbabwe Uzbekistan India Philippines Kenya Myanmar Mozambique Thailand Papua New Guinea Pakistan Ethiopia Bangladesh Indonesia Nigeria DR Congo China Angola Somalia DPR Korea Europe The Americas Africa South-East Asia Eastern Mediterranean Western Pacific Global 0 50 100 150 Treatment coverage (%) African Region (Fig. 4.19). In 2015, enrolments outstripped notifications of MDR/RR-TB in eight high MDR-TB burden countries (Fig. 4.12). This may be caused by empirical treatment of TB patients considered at risk of having MDR/ RR-TB but for whom a laboratory-confirmed diagnosis was missing, incomplete reporting of laboratory data, or enrolment of “waiting lists” of people with MDR/RR-TB who were detected before 2015. The ratio of enrolled to diagnosed cases was below 60% in two high MDR-TB burden countries in 2015: China (59%) and Nigeria (53%). These low ratios show that progress in detection is far outstripping capacity to provide treatment; they may also reflect weaknesses in data collection systems. Treatment coverage will not improve globally unless there is an intensification of efforts in the countries with the largest burden, particularly China and the Russian Federation, but also India where the rate of increase in enrolments has slowed. In many countries, one of the reasons for inadequate access to treatment of drug-resistant TB is that the network for the programmatic management of drug-resistant TB (PMDT) is too centralized. Hospital-based models of care continue to dominate in many countries, and hold back wider use of decentralized ambulatory care, a change of direction that could expand population access to PMDT (see also Chapter 6). In addition, gaps for palliative and end-oflife care are evident. In 2015, only 34 countries (including 16 of the 30 high MDR-TB burden countries) reported that such services were provided within the scope of their NTPs. 4.3 Treatment outcomes This section highlights the latest results of treatment for people who started TB treatment on a first-line regimen in 2014, and people that started a second-line regimen for MDR/RR-TB in 2013. 4.3.1 Treatment outcomes for new and relapse TB patients The definitions of TB treatment outcomes for new and relapse cases of TB that are recommended by WHO are provided in an updated recording and reporting framework 76 :: GLOBAL <strong>TUBERCULOSIS</strong> REPORT 2016
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GLOBAL REPORT TUBERCULOSIS 2016
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WHO Library Cataloguing-in-Publicat
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:: Abbreviations aDSM AE AIDS ART A
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The principal source of financial s
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Zhumagali Ismailov, Sarah Jackson,
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:: Executive Summary Background The
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TB prevention services South Africa
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Chapter 1 :: Introduction Tuberculo
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:: Box 2.1 The Sustainable Developm
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:: Box 2.3 The End TB Strategy at a
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:: TABLE 2.1 Top 10 indicators (not
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TABLE 2.2 :: The three TB high-burd
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Chapter 3 :: TB disease burden :: K
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:: Box 3.1 The WHO Global Task Forc
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:: Box 3.2 Updates to estimates of
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:: Box 3.3 Updated and interim esti
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:: FIG. 3.1 Strengthening national
Page 36 and 37: :: TABLE 3.2 Estimated epidemiologi
Page 38 and 39: :: FIG. 3.3 Estimated TB incidence
Page 40 and 41: :: FIG. 3.5 Global trends in the es
Page 42 and 43: :: FIG. 3.8 Trends in estimated TB
Page 44 and 45: :: FIG. 3.10a Top causes of death w
Page 46 and 47: :: FIG. 3.14 Trends in estimated TB
Page 48 and 49: :: FIG. 3.16 Data sources available
Page 50 and 51: :: TABLE 3.5 Estimated incidence of
Page 52 and 53: :: FIG. 3.20 Estimated incidence of
Page 54 and 55: :: FIG. 3.22 Global progress in imp
Page 56 and 57: :: TABLE 3.6 Number of TB cases fou
Page 58 and 59: :: TABLE 3.7 HIV-negative and HIV-p
Page 60 and 61: :: FIG. 3.29a The prevalence:notifi
Page 62 and 63: :: FIG. 3.31b The average CFR by st
Page 64 and 65: SIM and SINAN case-based databases,
Page 66 and 67: Prompt and accurate diagnosis of tu
Page 68 and 69: :: FIG. 4.2 New and relapse TB case
Page 70 and 71: :: FIG. 4.5 Percentage of new and r
Page 72 and 73: :: FIG. 4.8 Global numbers of notif
Page 74 and 75: :: TABLE 4.4 National guidance in p
Page 76 and 77: :: FIG. 4.9 Percentage of bacteriol
Page 78 and 79: :: FIG. 4.12 Number of MDR/RR-TB ca
Page 80 and 81: :: FIG. 4.14 Case notification rate
Page 82 and 83: :: FIG. 4.16a The ten countries wit
Page 84 and 85: :: Box 4.5 Community contributions
Page 88 and 89: issued in March 2013 and updated in
Page 90 and 91: :: FIG. 4.22 Treatment outcomes for
Page 92 and 93: :: Box 4.6 Active TB drug-safety mo
Page 94 and 95: Prevention of new infections of Myc
Page 96 and 97: :: TABLE 5.2 TB preventive treatmen
Page 98 and 99: :: TABLE 5.3 Provision of TB preven
Page 100 and 101: :: FIG. 5.5 Coverage of BCG vaccina
Page 102 and 103: This chapter aims to provide a tube
Page 104 and 105: :: FIG. 6.2 Government spending on
Page 106 and 107: :: Box 6.1 Implications for TB of e
Page 108 and 109: :: Box 6.2 Innovations in engaging
Page 110 and 111: :: Box 6.4 Reforming systems to exp
Page 112 and 113: :: TABLE 6.1 TB patient social supp
Page 114 and 115: :: FIG. 6.5 Surveys of costs faced
Page 116 and 117: :: TABLE 6.3 Status of selected SDG
Page 118 and 119: Continue current trend (base case s
Page 120 and 121: can provide insights into progress
Page 122 and 123: lion, most (US$ 4.4 billion, 67%) i
Page 124 and 125: :: Box 3.2 Updates to estimates of
Page 126 and 127: :: FIG. 7.5 Funding for NTP budgets
Page 128 and 129: :: Box 7.2 International donor fund
Page 130 and 131: :: FIG. 7.6 Reported funding gaps f
Page 132 and 133: :: Box 7.3 Methods used to estimate
Page 134 and 135: :: Box 8.1 WHO’s Global Action Fr
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is critical to allow for the time-s
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:: FIG. 8.2 The global development
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:: FIG. 8.3 The development pipelin
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Annex 1 Access to the WHO global TB
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A data dictionary that defines each
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Annex 2 Country profiles :: FOR 30
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Bangladesh population 2015 :: 161 m
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China population 2015 :: 1 376 mill
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Democratic Republic of the Congo po
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India population 2015 :: 1 311 mill
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Kenya population 2015 :: 46 million
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Myanmar population 2015 :: 54 milli
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Pakistan population 2015 :: 189 mil
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Russian Federation population 2015
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Thailand population 2015 :: 68 mill
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Viet Nam population 2015 :: 93 mill
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Central African Republic population
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Lesotho population 2015 :: 2.1 mill
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Namibia population 2015 :: 2.5 mill
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Sierra Leone population 2015 :: 6.5
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Zimbabwe population 2015 :: 16 mill
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WHO African Region WHO MEMBER STATE
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WHO Eastern Mediterranean Region WH
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WHO South-East Asia Region WHO MEMB
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Annex 4 TB burden estimates, notifi
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:: TABLE A4.1 TB incidence estimate
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:: TABLE A4.1 Table TB incidence A4
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:: Table TABLE A4.2 A4.2 Estimates
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Table :: TABLE A4.2 A4.2 Estimates
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:: TABLE A4.3 Measured percentage o
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:: TABLE A4.3 Measured Table A4.3 p
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:: TABLE A4.4 TB case notifications
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:: TABLE A4.4 TB case notifications
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:: TABLE A4.5 Treatment outcomes by
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:: TABLE A4.5 Treatment outcomes by
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ISBN 9 789241 565394 Ending TB by 2
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