Multidrug-/ rifampicinresistant. (MDR/RR-TB): Update 2017

Transcription

1 Multidrug-/ rifampicinresistant TB (MDR/RR-TB): Update 2017

2 The global TB situation (1) Estimated incidence, 2016 Estimated number of deaths, 2016 All forms of TB HIV-associated TB Multidrug- / rifampicin-resistant TB (MDR/RR-TB) 10.4 million ( million) 1.0 million ( million) 600,000 (540, ,000) 1.3 million* ( million) 374,000 (325, ,000) 240,000 (140, ,000) Source: WHO Global Tuberculosis Report 2017 * Excluding deaths attributed to HIV/TB

3 The global TB situation (2) TB incidence and mortality,

4 The Global Project on Anti-TB Drug Resistance Surveillance, Global Project launched SRL network launched 1st global DRS report 2nd global DRS report 3rd global DRS report 4th global DRS report M/XDR-TB report Global TB reports st ed. DRS guidelines 2nd ed. DRS guidelines 3rd ed. DRS guidelines 4th ed. DRS guidelines 5th ed. DRS guidelines

5 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. WHO All rights reserved

6 Measuring TB drug resistance Periodic surveys vs. continuous surveillance

7 Measuring TB drug resistance Year of most recent data

8 Percentage of new and previously treated TB cases with MDR/RR-TB, 2016 a Best estimates are for the latest available year

9 % MDR/RR-TB in new TB cases Figures are based on the most recent year for which data have been reported, which varies among countries. Data reported before 2002 are not shown

10 % MDR/RR-TB in previously treated TB cases Figures are based on the most recent year for which data have been reported, which varies among countries. Data reported before 2002 are not shown. The high percentages of previously treated TB cases with MDR-TB in Bahamas, Belize, French Polynesia, Puerto Rico and Sao Tomé and Principe refer to only a small number of notified cases (range: 1 8 notified previously treated TB cases).

11 30 high MDR-TB burden countries

12 Estimated incidence of MDR/RR-TB, 2016 for countries with at least 1000 incident cases

13 Trends in new TB (blue) and new MDR-TB (red) case rates selected high MDR-TB burden countries

14 Isoniazid-resistant TB cases (Hr-TB) Relative burden of Hr-TB among all new and all retreatment TB cases notified globally in 2016 (compared with RR-TB)

15 Pyrazinamide resistance Source: Zignol M et al. Lancet Infect Dis Jul 7. pii: S (16)

16 Countries ever notifying an XDR TB case 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. WHO 2017 All rights reserved

17 Moxifloxacin resistance Source: Zignol M et al. Lancet Infect Dis Jul 7. pii: S (16)

18 DR-TB RESPONSE

19 Diagnostic DST (1) % of bacteriologically confirmed TB cases tested for RR-TB

20 Diagnostic DST (2) % of MDR/RR-TB cases with DST results for fluoroquinolones and 2 nd line injectable agents

21 MDR/RR-TB detection and treatment MDR/RR-TB cases detected (violet) and number enrolled on MDR-TB treatment (green) , compared with incident MDR/RR-TB cases in 2016 (uncertainty interval shown in blue)

22 MDR/RR-TB treatment coverage Enrolments on MDR-TB treatment as a % of the incident MDR/RR-TB cases, 30 high MDR TB burden countries, regions and globally, 2016

23 Countries that had used shorter MDR-TB treatment regimens by the end of 2016 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. WHO All rights reserved

24 Number of patients with laboratory-confirmed XDR-TB started on treatment in 2016 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. WHO All rights reserved

25 Outcomes of MDR/RR-TB treatment Annual cohorts, by WHO region and global,

26 Outcomes of XDR-TB treatment 2014 cohort, by WHO region and global *number of cases observed shown next to the bars

27 Use of SMS, video supported treatment or electronic medication monitors to improve TB treatment adherence and delivery, 2016 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. WHO All rights reserved

28 MDR/RR-TB and financing (1) Funding for prevention, diagnosis and treatment by intervention area, (constant 2017 US$ billions)

29 MDR/RR-TB and financing (2) Estimated funding needed for TB control in low- and middle-income countries,

30 MDR/RR-TB and financing (3) Funding for drug-susceptible TB (green) and MDR-TB (brown), , by country group (constant 2017 US$ millions)

31 MDR/RR-TB and financing (4) Estimated cost per patient treated for MDR-TB, 2016* * Limited to 80 countries with at least 20 patients on MDR-TB treatment in 2016

32 Conclusions Although only 4.1% of new and 19% of retreatment TB cases have MDR/RR-TB, globally they amount to ~600,000 incident cases each year, challenging the prospect of ending TB by 2035 Coverage of DST for first and second-line TB medicines is improving but only a minority of MDR/RR-TB and XDR-TB patients are being detected and placed on adequate treatment Surveillance and monitoring continue to improve. Digital technologies offer an opportunity to help bridge some of the weaknesses in data management as well as for patient care (e.g. adherence support) New policy issued by WHO in promotes novel treatment regimens. Scale-up of such treatment options is needed to impact global success rates for drug-resistant TB patients, especially in countries with large burdens.

33 In summary 5 priority actions

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