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Global targets for TB and HIV: Where are we in the European Union? Marieke J. van der Werf Wolfheze Workshops, The Hague, 15 May 2019
Global targets for TB and HIV: Where are we in the European Union?
Marieke J. van der Werf
Wolfheze Workshops, The Hague, 15 May 2019
Sustainable Development Goals and communicable diseases
Source: www.un.org/sustainabledevelopment/health 2
Goal 3. Ensure healthy lives and promote well-being for all at all ages
3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
WHO End TB Strategy targets
By 2030 compared with 2015
• 90% reduction in number of TB deaths
• 80% reduction in TB incidence rate
• 0% TB-affected families facing catastrophic costs due to TB
Source: World Health Organization, End TB Strategy, A67/11 – 14 March 2014 3
Progress towards the TB targets, EU/EEA, 2008-2017
Source: Merk et al. Eurosurveillance 2019 4
1
10
100
2008 2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030
Case
s /
100 0
00
80% reduction
TB notification rate
1
10
100
1,000
10,000
2008 2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030
Num
ber
of
TB d
eath
s
Number of TB deaths
90% reduction
Progress towards the TB targets, EU/EEA
TB-affected families facing catastrophic costs due to TB
5
United Nations High Level Meeting political declaration on TB
6
To diagnose and successfully treat 40 million TB cases, including
• 3.5 million children with TB
• 1.5 million people with drug-resistant TB
and
To prevent tuberculosis by provision of preventive treatment
to 30 million people
by 2022
Country level targets proposed by the Stop TB Partnership
Country TB MDR TB Childhood TB
Austria 600 4 34
Belgium 1 100 9 66
Bulgaria 1 500 26 100
Croatia 400 0 8
Cyprus 52 0 3
Czech Republic 500 4 14
Denmark 300 0 13
Estonia 200 33 5
Finland 200 5 8
France 5 100 79 300
Germany 6 000 0 300
Greece 400 0 23
Hungary 600 16 10
Iceland 16 0 0
Ireland 300 4 12
Italy 4 300 0 200
Latvia 500 25 12
Lithuania 1 400 256 55
Luxembourg 33 1 2
Malta 45 0 0
Netherlands 800 11 39
Norway 200 10 19
Poland 5 800 44 100
Portugal 1 800 10 54
Romania 12 500 384 600
Slovakia 200 7 45
Slovenia 100 0 4
Spain 4 500 0 300
Sweden 500 10 28
United Kingdom 5 300 48 200
Total EU/EEA 55 246 986 2 554http://www.stoptb.org/global/advocacy/unhlm_targets.asp 7
Number of cases to be successfully treated in 2018
TB cases diagnosed and successfully treated, EU/EEA
8
0
10,000
20,000
30,000
40,000
50,000
60,000
2016 2017 2018 2019 2020 2021 2022
Num
ber
of
TB c
ase
s
Target: Successfully treated
Diagnosed
Successfully treated
Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018–2016 data
TB preventive treatment
Preventive treatment coverage of childhood TB contacts aged under five years
- 3 EU/EEA Member States reporting in 2017
- 47.9% coverage
9Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018–2016 data
Global target 30 million people
No country level targets for low burden higher income countries
UNAIDS targets for ‘ending the AIDS epidemic’
Source: (UNAIDS 2015). On the Fast-Track to end AIDS. UNAIDS 2016-2021 Strategy 10
By 2020(Fast-track targets)
By 2030(SDG targets)
√ To reduce new HIV infections to fewer than 500 000 by 2020
√ Zero new infections
√ To reduce AIDS-related death to fewer than 500 000 by 2020
√ Zero AIDS deaths
√ To eliminate HIV-related stigma and discrimination by 2020
√ Zero discrimination
Are we on track to end AIDS?
Source: UNAIDS 2018, ECDC/WHO, HIV Surveillance in Europe 2018, 2017 data 11
0
5000
10000
15000
20000
25000
30000
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Esti
mat
ed n
ew H
IV in
fect
ion
s
EU/EEA estimated infections 2020 target, EU/EEA
23,000
6,000
TARGET: 75% reduction in new
infections by 2020 (baseline 2014)
UNAIDS targets
By 2020
12
Target 1 Target 2 Target 3
Progress toward achieving the 1st 90:90% of all PLHIV who know their status (n=23)
Source: ECDC. Dublin Declaration monitoring 2018; Brown et al Eurosurveillance 2018.Latest available data reported, ranging from 2014-2017.
13
Target reached within 10% of target >10% from target
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Global target 90%
EU/EEA 87%
Progress toward achieving the 2nd 90:90% of those diagnosed on ART (n=22)
Source: ECDC. Dublin Declaration monitoring 2018; Brown et al Eurosurveillance 2018.Latest available data reported, ranging from 2014-2017.
14
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Target reached >10% from target
Global target 90%
Overall EU/EEA 91%
within 10% of target
Progress toward achieving the 3rd 90:90% of those on ART virally suppressed (n=20)
Source: ECDC. Dublin Declaration monitoring 2018; Brown et al Eurosurveillance 2018.Latest available data reported, ranging from 2014-2017.
15
Target reached within 10% of target >10% from target
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Global target 90%
EU/EEA 92%
Summary: Progress toward achieving the 90-90-90 HIV targets in the EU/EEA
ECDC. Continuum of HIV care. Monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia: 2018 progress report. Stockholm: ECDC; 2018 16
100%
87%
79%
73%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PLHIV Diagnosed On treatment Virally suppressed
90%
81%
73%
Conclusions
Monitoring
• Some targets are not measured in the EU/EEA
➢ % TB-affected families facing catastrophic costs due to TB
➢ HIV-related stigma and discrimination
• Not all Member States report on all targets
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Tuberculosis
The EU is not on track to reach the SDG targets of 80% reduction in TB incidence and 90% reduction in number of TB deaths
Targets for diagnosis and successfully treated can be reached
HIV/AIDS
The EU is not on track to meet the SDG target of 75% fewer infections
90-90-90 targets can be reached
Acknowledgements
ECDC HIV STD and hepatitis programme staff
ECDC TB programme staff
Nominated operational contact points for HIV and TB surveillance from European Union/European
Economic Area (EU/EEA) Member States
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