Moving ahead with the Stop TB Strategy: where are we today?

Dr Mario Raviglione

Director, WHO Stop TB Department

Joint Meeting of Core Teams and High Burden

Countries

Paris, 30 October 2006

The burden of TB in 2005

1.6 million deaths in 2005 – 98% of these in developing world

219,000 deaths due to TB/HIV

MDR-TB present in 102 of 109 countries and settings surveyed, XDR-TB emerging

8.9 million new cases in 2005 – 80% in 22 high-burden countries

Highest incidence rates per capita in Africa Highest numbers in Asia - Emergency in Europe

= 300 or more

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 2005. All rights reserved

Global TB control targets

2005: World Health Assembly:- To detect at least 70% of infectious TB cases- To treat successfully at least 85% of detected cases

2015: 50% reduction in TB prevalence and death rates by 2015

2015: Goal 6: Combat HIV/AIDS, malaria and other diseases Target 8: to have halted by 2015 and begun to reverse the incidence… Indicator 23: prevalence and deaths associated with TB

Indicator 24: proportion of TB cases detected and cured under DOTS

Over 26 million patients treated under DOTS with high cure rates

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1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

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Target cure 85% Target detection 70%

Trends in global TB prevalence and deaths

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TB prevalence TB deaths

Africa epidemic possibly peaking:

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World excluding AFR and EEUR

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• 1990 • 1992 • 1994 • 1996 • 1998 • 2000 • 2002 • 2004

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Global incidence flattening?

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XDR-TB: extensive drug-resistance TB

XDR: MDR-TB plus resistance to any fluoroquinolone and, at least, 1 of 3 injectables (ami, kana or capreo)

Of 17,690 isolates from 49 countries during 2000-2004 20% were MDR; 2% XDR

XDR found in: USA: 4% of MDRLatvia: 19% of MDRS Korea: 15% of MDR

XDR found in Southern Africa associated with HIV

1. New approach needed that built on DOTS, while mainstreaming responses to new threats, full partner engagement, service innovations and research

2. Wide consultation with NTPs and partners on components

3. 250 stakeholders interviewed on key messages of new approach • Should reinforce "access to all" and "impact" implications • Should recognize both "individual" and "public health" aims• Further clarify how to work within systems, serve hard-to-reach and

research roles

4. Approved by the WHO Strategic and Technical Advisory Group for TB (STAG-TB)

5. Endorsed by the Stop TB Working Groups and partners

6. Endorsed by Stop TB Partnership Coordinating Board

Stop TB Strategy – Development 2004-2005

Vision: A WORLD FREE OF TB

Goal: To dramatically reduce the global burden of TB by 2015 in line with the MDGs and the Stop TB Partnership targets

Objectives:

• Achieve universal access to high-quality diagnosis and patient-centred treatment

• Reduce the human suffering and socio-economic burden associated with TB

• Protect poor and vulnerable populations from TB, TB/HIV and multidrug-resistant TB

• Support development of new tools and enable their timely and effective use

Stop TB Strategy Vision, Goals, Objectives

Stop TB Strategy to reach the 2015 MDGs

In conclusion…In conclusion…

New challenges require the new Stop TB Strategy

The new Stop TB Strategy underpins and strengthens the Global Plan to Stop TB, 2006-2015

The Strategy & The Plan...

Roll-out of the Strategy

• Global Plan to Stop TB, 2006-2015, January 2006

• The Lancet and World TB Day, March 2006

• Survey of HBCs for 2007 Global TB Control Report

• Planning and implementation support to countries ongoing

• WHO Stop TB Strategy document, June 2006

• 3 WHO Regional Stop TB plans based on Strategy; others in process

Some interim indicators on implementation ofStop TB Strategy components 1, 2, 3

WHO Questionnaire of 22 HBCs, 2006

Some interim indicators on implementation ofStop TB Strategy components 4, 5, 6

WHO Questionnaire of 22 HBCs, 2006

• The highest priority is basic DOTS quality -– Where DOTS has been scaled up very fast – Where health systems, HRH and labs are very weak – Where HIV epidemic and MDR-TB problems are the most severe

• Catch 22 - Governments and partners with the least capacity often have the greatest need for new approaches. Implementing new approaches while building capacity demands new resources and partners

• Scaling up - We need to work in a new way – piloting, assessing & sharing results, while preparing and initiating scaling up. Sequential approaches won't work.

• Accountability – High demands from donors and civil society for documented results

Key challenges

• Country-led planning and immediate action with expanded range of partners

• High-level country-based advocacy for increased national budgets and human resources to respond, within overall sector plans

• High-level regional and global advocacy– Regional Ministerial Fora 2007 – Africa, Europe– Regional political bodies (RCs) and partnerships– Focus on Asia session at Stop TB CB, 11- 2006– Latin America Initiative by SE Sampaio, 11-2006– G8 in Germany, 6-2007– Key bilaterals, multilaterals, and world leaders

engaged against poverty and HIV and for MDGs, HSS and R&D

Next Steps