Accelerating advocacy on TB/HIVVienna, 15 July 2010
TB/HIV in the WHO European Region
Smiljka de LussignyAndrei Dadu, Martin Donoghoe & Richard Zaleskis
Communicable Diseases UnitWHO Regional Office for Europe
Presentation outline
Epidemiology in WHO European Region – TB, HIV & HIV/TB
Regional specificities
Surveillance: most important impact TB indicators
25 - 26 May 2009 3
Indicator What to measure How to measure
Incidence rate(/100,000)
New TB cases estimated in one year-------------------------------------------------- x 100,000Total midyear population
x determinants coefficient
Notification rate(/100,000)
New TB cases notified in one year-------------------------------------------------- x 100,000Total midyear population
Notifications of TB
Case detection rate (%)
New TB cases notified in one year-------------------------------------------------- x 100New TB cases estimated in one year
Reports TB case finding
Prevalence rate(/100,000)
New and old TB cases estimated in one year----------------------------------------------------------- x 100,000Total midyear population
TB prevalence survey
Mortality rate(/100,000)
TB deaths in one year-------------------------------------------------- x 100,000Total midyear population
Vital registration
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Source: Global tuberculosis control: a short update to the 2009 report. WHO/HTM/TB/2009.426
Global & European Region TB burden (2008)
TB case notified in 2008 in the WHO European Regions
EMR7%
AFR23%
AMR4%
EUR6%
SEAR36%
WPR24%
9.4 mln new TB cases estimated globally in 2008 (139 per 100 000 population)
6% contribution of European Region to the Global burden
In 2008, 50 (of 54) countries from the Region reported a total of 461,645 TB cases
The overall TB notification rate was 52.2 per 100,000 population
46% notified cases from Russia
87.6% contribution of 18 HPC to the Regional TB burden
5
TB burden WHO European Region (2008)
6
TB notification* rate and estimated incidence WHO European Region (1980-2008)
* Newly notified episodes (TB cases) = new cases + relapses*** excluding Bulgaria and Romania that become EU in 2007
ArmeniaAzerbaijanBelarusBulgariaEstoniaGeorgiaKazakhstanKyrgyzstanLatvia LithuaniaMoldovaRomaniaRussian Fed.TajikistanTurkeyTurkmenistanUkraineUzbekistan
** 18 High Priority Countries
Case Detection Rates WHO Regions (2008)
Overall, about 61% (5.5 million) of the estimated number of incident cases detected Case-detection has been stagnating globally since 2006.
8
Notified and estimated TB mortality rates WHO European Region (2003-2007)
9
CDR and TSR of new SS‘+’ TB,18 HPC, 2008
ARM
AZE
BLR
BUL
EST
GEOKAZ
KGZ
LVA
LTU
MLD
ROM
RUS
TJK
TURTKM
UKR
UZB
0
10
20
30
40
50
60
70
80
90
100
0 10 20 30 40 50 60 70 80 90 100 110 120
TSR (average in EUR) in 2005: 52/71TSR (average in EUR) in 2006: 55/70
Estimated number ofMDR-TB cases (2009)
10
0-<4,000
4,000-<10,000
10,000-<40,000
approximately 100,000
Among all incident TB cases globally an estimated 3.6% are MDR-TB
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MDR-TB prevalence WHO European Region (2008)
* M/XDR-TB: 2010 global report on surveillance and response (WHO/HTM/TB/2010.3)** TB surveillance in Europe 2008: report (ISBN 978-92-9193-207-8; ECDC, 2010)*** Data considered reliable if 50% of all cases were culture-positive, and 80% of them had reported DST results.
Estimated MDR prevalence, among all TB cases
19.1%
(81,000 cases)*
Notified MDR prevalence, among all TB cases
18.1 %
(18,365 cases)**
Detection Rate of all MDR‐TB cases
22.7 %
Out of 27 countries that account for 85% of all MDR-TB cases, 15 are in the European Region
Cumulative number of reported HIV/AIDS casesin WHO European Region 1985-2008
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
1,100,000
1,200,000
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
HIVAIDSAIDS deathspeople on HAART
2%
<20%
20-40%
40-60%
60-80%
6%
5%
11%
9%
>80%
75%
25.5%
9%
5%
88%
57%
80%
28%
65%
57%
59%
16%
13%
17%
4%
15%
16%
<1%
23%
82%
50%61%
14%
71%
11%
5%
IDU as % of all HIV/AIDS cases with known transmission route
NOTE: % of AIDS cases in countries not reporting HIV: France, Italy, Spain Sources: WHO/ECDC, national reports.
11%
15%
26%
5%
77%
2%
17%
0%9%
1%
16%
24%
25%
16%
29%
76%
73%
73%
66%
78%
42%
4%
3%
Scaling up treatment in Europe
16,000
18,00021,000
396,000380,000
350,000335,000
320,000305,000
290,000266,000
35,000
87,000
55,000
27,00023,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
Feb-03
Apr-03
Jun-0
3Aug
-03Oct-
03Dec
-03Feb
-04Apr
-04Ju
n-04
Aug-04
Oct-04
Dec-04
Feb-05
Apr-05
Jun-0
5Aug
-05Oct-
05Dec
-05Feb
-06Apr
-06Ju
n-06
Aug-06
Oct-06
Dec-06
Feb-07
Apr-07
Jun-0
7Aug
-07Oct-
07Dec
-07Feb
-08Apr
-08Ju
n-08
Aug-08
Oct-08
Dec-08
Central and Eastern EuropeWestern Europe
TB/HIV co-infectionWHO European Region (2008)
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• Оценочнаяраспространённость ВИЧ-инфекции среди случаев ТБ = 5.6% ( 23.800 people)• HIV testing coverage = 79% ( 357.000 patients)• HIV prevalence among tested TB = 3.0% ( 11.500 patients)• 48% of TB/HIV patients are detected• 28% of TB/HIV patients are covered by ARV treatment
HIV testing and treatment in TB patients, by WHO Regions (2008)
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HIV case finding among TB patients TB case finding among PLHIVNumber of
TB patients with known HIV status (thousands)
% of notified TB patients tested for
HIV
% of tested TB patients
HIV-positive
% of estimated
HIV-positive TB
casesidentified by testing
% of identified
HIV-positive TB patients started on
CPT
% of identified
HIV-positive TB patients started on
ART
Regional distribution
of estimated TB among HIV-positive
(%)
Number of HIV-positive screened
for TB (thousands)
Number of HIV-positive
people provided
IPT (thousands)
AFR 636 45 46 27 73 30 78 729 26AMR 113 49 15 45 36 67 2.7 48 12EMR 22 5.4 4.1 5.8 39 55 1.1 12 0.7EUR 357 79 3.3 48 61 28 1.7 205 9.2SEA 94 4.1 18 9.3 54 35 13 300 0.2WPR 152 11 7.0 24 55 28 3.1 90 0.7Global 1374 22 26 25 71 32 100 1384 48
Regional challenges
Both epidemics spread within vulnerable “most at risk populations” i.e. drug users, prisoners and migrants
Out of the system, poor access to services, marginalized and stigmatized
Low uptake of HIV testing, limited access to ART
Limited collaboration between the vertical HIV and TB programmes (drug dependence, STIs, viral hepatitis)
Lack of integration between HIV and TB services
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