On the road to

END TB

Dr Mario RAVIGLIONE
Director
Citizen News Service Webinar in lead up to World TB Day 2016
22 March 2016

Overview
TB burden
Progress and response

The commitment to end TB

The Global Burden of TB, 2014

Estimated number
of cases
All forms of TB

Estimated number
of deaths

1.5 million*

9.6 million

140,000 in children
480,000 in women
890,000 in men

1 million children
3.2 million women
5.4 million men

HIV-associated TB
Multidrug-resistant
TB
Source: WHO Global TB Report 2015

1.2 million (12.5%)

480,000

390,000
190,000

* Including deaths attributed to HIV/TB

TB ranks alongside HIV

as a leading cause of death
2012, WHO Global Health Observatory

2014, WHO and UNAIDS

TB

HIV/AIDS
TB

In grey: TB/HIV deaths

HIV/AIDS

Millions

TB incidence: countries and regions

Americas
Europe
3%

E. Mediterranean
8%

Africa
28%

Top 5:
23% in India
10% each: Indonesia & China
5% each: Nigeria & Pakistan

3%

South-East
Asia
41%

TB/HIV: 1.2 million cases in 2014

12.5% of all new cases
Estimated HIV prevalence in new TB cases, 2014

emerging in other regions

Ref: Global TB Control Report 2015

74% of TB/HIV cases

in Africa
Other co-morbidities

MDR-TB: 480,000 cases in 2014

3% of new TB cases globally
Ref: Global TB Control Report 2015

Percentage of new TB cases with MDR-TB

Highest % in the former USSR countries

India, China, Russia, Pakistan and Ukraine

have 62% of all MDR-TB cases

Tremendous
progress in the
fight against TB

MDG6 TB target achieved

Rate per 100,000 population

REVERSED

Incidence
Falling 1.5% per
year (2000-2014).
18% drop since 2000

1990

2000

2014

47% drop in TB mortality

SINCE 1990

Rate per 100,000 population

Most of the improvement

is since 2000

Target

47% decline since 1990

1990

2000

2015

43 million lives saved

BETWEEN 2000 AND 2014

TB = 43m

HIV = 7.8m
Malaria = 7m

Ref: Global TB Control Report

Global
commitment to
END TB

Global commitment to End TB

Moving from halting TB to ending TB by 2030

SDG TARGET 3.3 BY 2030

END THE TB EPIDEMIC

Vision, goal, targets, milestones

Vision:
A world free of TB
Zero TB deaths,
Zero TB disease, and
Zero TB suffering

Goal:
End the Global TB
epidemic

The End TB Strategy: 3 pillars and 4 Principles

HIGHLIGHTS FROM THE 30 HIGHEST TB BURDEN

COUNTRIES: ON THE ROAD TO ENDING TB

Momentum already from countries and partners

to end TB

India expansion of capacity to test patients

rapidly using Xpert MTB/RIF and roll out of
bedaquiline for MDR-TB treatment

South Africa - greatly expanded access to Xpert

MTB/RIF and TB preventive treatment for PLHIV
(60% largest coverage in the world)

Russian Federation: High level commitment

Thailand- Access to treatment for all residents

including migrants

Brazil and Viet Nam Research capacity building

Looking forward:
Priorities for action
6 PRIORITIES FOR ACTION
Ensure diagnosis and quality care for the
missed cases (3.6 million)
Address MDR-TB as a crisis
Accelerate response to TB/HIV
Address TB within universal health
coverage, social protection and poverty
agendas
Intensify research and ensure rapid
uptake of innovations
Increase financing to close resource gaps

Reaching the "missed" cases early is crucial

(~3.6 million not diagnosed or reported)

9.6 million estimated

Share of total missed cases

6 million notified

Estimated incidence
Global notifications

10 countries account for 75%

(2.7 million) of the estimated
missed cases globally
Indonesia + India:
1.2 million missed people
Ref: Global TB Control Report 2015

Addressing the MDR-TB public health crisis

480 000

cases of MDR-TB estimated in 2014

123 000

111 000

50%
50%
Three out of the 27 high MDR-TB countries achieved a
treatment success rate of 75%

Dual epidemic of TB and Diabetes

About 10% of TB cases globally may be linked to
diabetes
466 million people had diabetes in 2014
TB and diabetes fuel each other:
Diabetes triples a persons risk of developing TB
The likelihood that a person with TB will die or relapse
is significantly higher among people with diabetes.
Research shows that diabetic patients treated for TB
remain contagious longer than non-diabetics
TB can temporarily cause impaired glucose tolerance
which is a risk factor for developing diabetes
TB and Diabetes collaborative framework countries
moving forward to adopt and implement this

Critical funding gaps can

compromise efforts to save lives
IMPLEMENTATION

US$8 billion needed in 2015

$1.4 billion
funding gap

$ 6.6 billion available

in 2015

$8 billion funding required in 2015 for

TB prevention, diagnosis and treatment

RESEARCH

at least US$ 2 billion per year needed

$677
available
in 2013
$1.32 billion
funding gap

TAG TB R&D report 2014

Looking beyond 2015 - Ending TB

is one of the Best Returns on Investment
Development - The economics of optimism , Jan 24th 2015 - The debate heats up about what goals the world should set
itself for 2030

Let us
UNITE TO

END TB
Thank you.