La Lotta alla Tubercolosi. Matteo Zignol and Mario C. Raviglione Stop TB Department WHO, Geneva, Switzerland. Geneva March 2012

Transcription

1 La Lotta alla Tubercolosi Matteo Zignol and Mario C. Raviglione Stop TB Department WHO, Geneva, Switzerland Geneva March 2012

2 Overview of the presentation The global burden of tuberculosis The WHO STOP TB Department: core functions Possible areas of collaboration

3 Tuberculosis: basics Tuberculosis (TB) is one of the oldest diseases of humans. TB is a major cause of death worldwide. TB is caused by the bacterium Mycobacterium tuberculosis TB usually affects the lungs, although other organs are involved in 15-30% of cases. If properly treated, TB caused by drug-susceptible strains is curable in virtually all cases. If untreated, TB may be fatal within 5 years in 50 65% of cases.

4 Who carries the burden of tuberculosis? mostly, the most vulnerable TB spreads in poor, crowded & poorly ventilated settings 320,000 women and 100,000 children die of TB each year; 10 million TB orphans Migrants, prisoners, minorities, refugees face risks, discrimination & barriers to care TB linked to HIV infection, malnutrition, alcohol, drug and tobacco use, diabetes

5 The Global Burden of TB Estimated TB incidence rates, by country, 2010 All forms of TB TB cases per Estimated >=300 number No estimate of cases 8.8 million (range: million) Estimated number of deaths 1.45 million (range: million) HIV-associated TB 1.1 million (13%) (range: million) 350,000 (range: 320, ,000) Multidrug-resistant TB (MDR-TB) 440,000 (range: 390, ,000) about 150,000

6 Incidence of TB per 100,000 population, 2010

7 The 22 high TB burden countries Top 10 (by number of cases notified in 2010): Highest burden in Asia (59% of 8.8 million cases) India China South Africa Indonesia Pakistan Philippines Ethiopia Bangladesh Myanmar Russian Federation Highest rates in Africa, due to high HIV infection rate ~80% of HIV+ TB cases in Africa

8 % MDR-TB among new TB cases, <3 3-<6 6-<12 12-<18 >18 No data available Subnational data only

9 Estimated lives saved through collaborative TB/HIV interventions Cumulative = 910,000 (800,000 1,100,000)

10 The Global TB Control Targets 2015: Goal 6: Combat HIV/AIDS, malaria and other diseases Target 6c: to have halted by 2015 and begun to reverse the incidence *Indicator 6.9: incidence, prevalence and mortality associated with TB *Indicator 6.10: proportion of TB cases detected and cured under DOTS 2015: 50% reduction in TB prevalence and deaths by : elimination (<1 case per million population)

11 The global response: Stop TB Strategy & Global Plan 1. Pursue high-quality DOTS expansion To save lives, prevent suffering, protect the vulnerable, & promote human rights 2. Address TB-HIV, MDR-TB, and needs of the poor and vulnerable 3. Contribute to health system strengthening 4. Engage all care providers 5. Empower people with TB and communities 6. Enable and promote research

12 Rate per 100,000 population Progress to date Incidence Rate peaked in 2002 Falling 1.3% per year Cases falling since million patients cured, million lives saved compared to 1994 care standards 2015 MDG target on track: global TB incidence rate peaked in 2002, cases in 2006 BUT, TB incidence declining too slowly and not on track for 50% mortality decrease in Africa Mortality On track to target 40% decline since

13 Financing for TB control , 97 countries for which data are available 2012: Gap of 1 billion US$

14 BRICS mostly domestic funding Other HBCs ~50% is donor funding US$ millions US$ millions Domestic BRICS 96% domestic financing Grants Domestic Grants Other 17 high-burden countries 49% donor financing

15 WHO core functions 1. Providing leadership on matters critical to health and engaging in partnerships where joint action is needed; 2. Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; 3. Setting norms and standards and promoting and monitoring their implementation; 4. Articulating ethical and evidence-based policy options; 5. Providing technical support, catalyzing change, and building sustainable institutional capacity; 6. Monitoring the health situation and assessing health trends.

16 The WHO 13 strategic objectives 1. Communicable diseases 2. HIV/AIDS, tuberculosis and malaria 3. Noncommunicable conditions, mental disorders, violence & injuries, visual impairment 4. Pregnancy, neonatal, child & adolescent health, reproductive health, ageing 5. Emergencies, disasters, crises and conflicts 6. Tobacco, alcohol, drugs, unhealthy diets, physical inactivity and unsafe sex 7. Social and economic determinants of health, equity, gender, human rights 8. Environmental health 9. Nutrition, food safety and food security 10.Health services, governance, financing, staffing and management 11.Medical products and technologies 12.Partnership 13.Administration

17 Six expected results for SO-2 1. Guidelines, policy, strategy and other tools for improved care 2. Policy and technical support to countries to implement 3. Guidance and technical support for essential medicines, diagnostic tools and health technologies 4. Global, regional and national systems for surveillance, evaluation and monitoring 5. Advocacy and nurturing of partnerships at all levels 6. Research for new knowledge, intervention tools and strategies

18 STOP TB Department core functions 1. Provide global leadership on matters critical to TB; 2. Develop evidence-based policies, strategies and standards for TB prevention, care and control, and monitor their implementation; 3. Jointly with WHO regional and country offices, provide technical support to Member States, catalyze change, and build sustainable capacity; 4. Monitor the global TB situation, and measure progress in TB care, control, and financing; 5. Shape the TB research agenda and stimulate the generation, translation and dissemination of valuable knowledge; 6. Facilitate and engage in partnerships for TB action.

19 Director's Office (STB/DO) M. Raviglione, Director Programme Management Unit (PMU) W. Jakubowiak, Programme Manager Planning, Financing & Administration Stop TB Partnership Secretariat (TBP) L. Ditiu Executive Secretary Policy, Strategy & Innovations (PSI) D. Weil Coordinator Technical Support Coordination (TSC) M. Grzemska Coordinator TB Monitoring & Evaluation (TME) K. Floyd Coordinator TB/HIV, Community & Civil Society Engagement(THC) H. Getahun Coordinator MDR-TB/GLC Operations (MDR) P. Nunn Coordinator TB Diagnostics & Laboratory Strengthening (TBL) K. Weyer Coordinator Strategic planning & advocacy TB communications & awareness National, global & regional partnerships TB policy & STAG-TB Service delivery innovations & Public-Private Mix TB social determinants Resource mobilization & Information Regional collaboration & technical support TBTEAM Secretariat & Global Fund collaboration TBCARE collaboration DOTS Expansion Working Group Secretariat Paediatric TB TB surveillance & monitoring Drug resistance surveillance Epidemiology & impact assessment Economics, budgeting & financing TB/HIV policy, response and innovations Community- based TB care Engagement of NGOs & other CSOs TB/HIV Working Group Secretariat MDR-TB policy, response & innovations Global GLC Secretariat MDR-TB Working Group Secretariat Diagnostics & laboratory policy and innovations Global Laboratory Initiative Secretariat Supranational Reference Laboratory Network (SRLN) EXPAND-TB project Roll-out of new diagnostics Drugs & diagnostics procurement (GDF) TB Research Movement & innovations Facilities for access to TB care & innovative approaches for poor & vulnerable communities (TBREACH & CFCS) Global Fund collaboration Planning, budgeting, management & donor relations STB works with 6 WHO Regional Offices and TB staff in 45 WHO Country Offices 02 April 2012

20 STOP TB Department Director office Overall direction Post 2015 vision, strategy and targets for TB prevention, care and control

21 STOP TB Department 1. Policy, Strategy and Innovations Strategic and Technical Advisory Group for TB (STAG- TB) providing guidance on TB efforts Policy guidance on TB screening for earlier and full TB detection, use of new anti-tb medicines, and TB and nutrition Best practices in public-private collaboration, regulation and rational use of anti-tb medicines

22 STOP TB Department 2. Technical Support Coordination Coordination of technical assistance for support to Member States, and collaboration with the Global Fund and other key partners Policy guidance on childhood TB and support for effective diagnosis and child-friendly treatment

23 STOP TB Department 3. TB Monitoring and Evaluation Annual Global TB Reports and associated global TB database, with the latest epidemiological, surveillance, programmatic and financial data for all 194 Member countries Substantially improved estimates of TB disease burden, including TB in children, linked to development of updated approaches to TB care and control Guidance and support to the design, implementation and analysis of over 20 national TB prevalence and 30 drug resistance surveys New economic and financial analyses of TB control, including comprehensive analysis of trends in TB financing and economic evaluations of MDR-TB treatment

24 STOP TB Department 4. TB/HIV and Community Engagement Continued guidance and support to scaled-up and integrated collaborative TB/HIV activities Scaled-up community and NGO engagement for TB care, and generation of evidence

25 STOP TB Department 5. MDR-TB/GLC Operations Policy guidance for effective prevention and care for extensively-drug resistant TB (XDR-TB), reliable supply of quality second-line anti-tb medicines, and community and private sector engagement in MDR-TB care Management of Global GLC mechanism guiding regional and national MDR-TB technical support

26 STOP TB Department 6. TB Diagnostics and Laboratory Strengthening Policy guidance on new TB diagnostics and laboratory standards Coordinated scale-up of TB diagnostic capacity including use of new technologies to increase detection of HIVassociated and drug-resistant TB An expanded global network of supranational reference laboratories

27 A step ahead in diagnosis Introducing Xpert MTB/RIF WHO endorsement December 2010 Xpert MTB/RIF should be used as the initial diagnostic test in individuals suspected of having MDR-TB or HIV-associated TB (strong recommendation) Phased implementation & evaluation countries using it in mid-2011 and 40 by end 2011 Scale up

28 Roll-out of Xpert MTB/RIF As of end 2011

29 STOP TB Department Financing Total budget USD 36 million Funding gap USD 10 million Key financing partners: USA, Canada, Japan, Bill and Melinda Gates Foundation, UNITAID, UNAIDS, The Global Fund, Stop TB Partnership/DFID, Eli Lilly, and the Bristol Myers Squibb Foundation- Secure the Future.

30 Italian WHO Collaborating Centers for TB WHO CC for TB in Europe and Training Salvatore Maugeri Foundation, Tradate WHO CC for TB/HIV integrated activities University of Brescia, Brescia WHO CC for TB Laboratory Strengthening & Suprananational TB Reference Laboratory San Raffaele Scientific Institute, Milan Suprananational TB Reference Laboratory National Institute of Public Health, Rome

31 Possible areas of collaboration I Scale-up of Xpert MTB/RIF in African countries Countries Ethiopia Uganda Kenya Tanzania Mozambique Burkina Faso Technical partners WHO CC for TB Laboratory Strengthening San Raffaele Scientific Institute, Milan WHO CC for TB/HIV integrated activities University of Brescia, Brescia...

32 Possible areas of collaboration II Monitoring the emergence of drug-resistant TB (MDR, XDR, TDR) in Eastern European and African countries Countries Ukraine Rep. of Moldova Armenia Ethiopia Eritrea Burkina Faso Technical partners WHO CC for TB Laboratory Strengthening San Raffaele Scientific Institute, Milan WHO CC for TB in Europe and Training Salvatore Maugeri Foundation, Tradate

33 Many thanks to all