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1 Progress in tuberculosis care: setting the scene for Central Asia Name of the presenter Gombogaram Tsogt, Shalva Gamtsemlidze Quality Health Care Project
2 Global TB estimates All forms of TB greatest number of cases in Asia greatest rates per capita in Africa MDR-TB Estimeted number of cases 9.27 million (139 per 100,000) 511,000 Estimated number of deaths 1.77 million (18%) (25 per 100,000) ~150,000 (29%) XDR-TB ~50,000 ~30,000 (60%) HIV-associated TB 1,4 Million (15%) 456,000
3 The greatest tragedy that can happen to a tuberculosis patient is that his tubercle bacilli become resistant to standard drugs" (Sir John Crofton, 1959) MDR-TB % among new cases, >10.00 No data MDR-TB % among new cases, * Sub-national coverage in India, China, Russia, Indonesia. 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. ã WHO All rights reserved
4 World Health Day 2011
5 Why AMR is a global concern? Antimicrobial resistance (AMR) kills Challenges care and control of infectious diseases Greatly increases care costs Threatens a return to the pre-antibiotic era Jeopardizes healthcare gains for individuals and society Compromises health security, damages trade and economy Lack of coherent approaches to prevention and containment
6 What drives AMR? Role responsibilities of medical staff in providing multiple AB therapy Consumers, communities not sufficiently informed on the risks linked with misuse and overuse of AB Regulations on the sale of AB not enforced (over the counter sale) Surveillance systems weak or absent Systems for ensuring quality and supply of medicines inadequate, issue of counterfeit medicines Use of medicines inappropriate and irrational Infection prevention and control poor Antimicrobials and diagnostics arsenal limited Research and development for diagnostics and medicines insufficient
7 Treatment failure KAZ New SS KGZ New SS TJK New SS TKM New SS UZB New SS Retreatment Retreatment Retreatment Retreatment Retreatment
8 Treatment default KAZ New SS Relapse KGZ New SS Relapse TJK New SS Relapse TKM New SS Relapse UZB New SS Relapse
9 Fate of pulmonary TB SS+ patients who either did not receive treatment or had inadequate therapy 100 Chronic excretion of bacteria 80 percentage Negative results of bacteriological investigations 20 0 No intervention Inadequate intervention Died Grzybowski S, et al. Tubercle 1987;2(suppl):33-7
10 TB notification rates in CAR,
11 Plan «Stop TB» in Eastern Europe: implementation 99 countries reported treatment success rates 70% or over and DOTS detection rates 50% or over 32 countries (including 2 countries out of range of graph) have reached both targets.
12 WHA treatment success target reached in 2005 (globally) Percentage , million Europe: 71%, Africa: 76%, Americas: 78%
13 MDR-TB rate (%), Country Among new cases>12% Among retreatment cases>50% Azerbaijan, Baku Estonia 15.4 Kazakhstan Latvia 12.1 Republic of Moldova Russian Federation: Mari El and Tomsk Obl & 15.0 Ivanovo Obl Tajikistan, Dushanbe and Rudaki Ukraine (Donetsk Obl.) 16.0 Uzbekistan Karakalpakstan and Tashkent 13.2 & 14.8
14 KAZAKHSTAN By number of patients (world) 33 (213 countries) In European Region 4 (53 countries) MDR-TB prevalence 3 Treatment success 64% Incidence (per ) Prevalence (per ) Mortality (per ) MDR-TB Number of MDR-TB cases, new Number of MDR-TB cases, retreatment Total number of MDR-TB cases to be detected through laboratory investigations 6,051 8,471 6,401 5,689 5,784 6,043 6,068 5,893 5,860
15 KYRGYZSTAN By number of patients (world) 72 (213 countries) In European Region 10 (53 countries) MDR-TB prevalence 9 Treatment success 84% Incidence (per ) Prevalence (per ) Mortality (per ) MDR-TB Estimated number of MDR-TB cases Number of patients enrolled on treatment (16% of new cases and 61% of retreatment cases) % of patients enrolled on treatment out of estimated number of patients
16 TURKMENISTAN By number of patients (world) 99 (213 countries) In European Region 21 (53 countries) MDR-TB prevalence 0 Treatment success 83% Incidence (per ) 65,5 61,5 Prevalence (per ) 216,9 211,1 Mortality (per ) 7,3 6,5 MDR-TB Estimated number of MDR-TB patients Number of MDR-TB patients planned to be treated through the GF funding % out of total estimated number of MDR-TB patients
17 TAJIKISTAN By number of patients (world) 76 (213 countries) In European Region 13 (53 countries) MDR-TB prevalence 7 Treatment success 82% Incidence (per ) 83,8 78,7 Prevalence (per ) 205,1 195,2 Mortality (per ) 5,4 5,9 MDR-TB Estimated number of MDR-TB patients Number of MDR-TB patients planned to be treated Number of MDR-TB patients planned to be treated through the GF funding % out of total estimated number of MDR-TB patients
18 UZBEKISTAN By number of patients (world) 36 (213 countries) In European Region 5 (53 countries) MDR-TB prevalence 4 Treatment success 81% MDR-TB Incidence (per ) Prevalence (per ) Mortality (per ) Estimated number of MDR-TB cases, new Estimated number of MDR-TB cases, retreatment Number of MDR-TB patients planned to be treated
19 Cost of activities, 2011* (USD) Cost The world, excluding Eastern Europe Eastern Europe DOTS treatment (per patient) 382 ( ) 5,840 (5,640 6,190) MDR-TB treatment (per patient) 3,320 8,860 MDR-TB diagnosis (per lab test) Drug susceptibility test for SLD 118 ART (per patient, 6 months) 522 HIV test (per person) 9 14 Co-trimoxazole preventive therapy (per person) 4.7 *Cost increases by 3% per year due to inflation
20 TB Control Global Targets 2015: Goal 6: Combat HIV/AIDS, malaria and other diseases Target 6.c: to have halted by 2015 and begun to reverse the incidence Indicator 6.9: incidence, prevalence and deaths associated with TB Indicator 6.10: proportion of TB cases detected and cured under DOTS 2015: 50% reduction in TB prevalence (65/100,000 in 2004) and deaths (8/100,000 in 2004) compared with their levels in : elimination (<1 case per million population)
21 THE STOP TB STRATEGY
22 COMPONENTS OF STOP TB STRATEGY 2. Address TB/HIV, MDR-TB and other challenges Implement collaborative TB/HIV activities Prevent and control MDR-TB Address prisoners, refugees and other high-risk groups and situations
23 Drug resistance and tuberculosis control Be aware of resistance problem Surveillance Resolve resistance problem Treatment with SLDs Prevent resistance problem Adequate treatment (in line with standards)
24 Treatment duration of sensitive and resistant tuberculosis TB 6 months MDR-TB 4 drugs Treatment success up to 95%, side effects 2% MDR-TB 24 months XDR-TB 6-7 drugs Treatment success up to 70-75%, side effects up to 20%
25 Will a physician be able to cure a patient using SLDs if he could not achieve cure through DOTS? Will a patient be able to complete a treatment course with SLDs if he could not complete DOTS treatment? If Yes, what needs to be changed?
26 If you miss the first buttonhole, you can t ever get fully buttoned up Johann Wolfgang von Goethe
27 Найди ТБ Излечи ТБ
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