Transcript Slide 1

Pre-Conference Workshop 1
National TB Control Program
Summary & Remarks
Dr Ral Antic
Chair Scientific Committee IUATLD-APR
Australia
TB Control in WPR-current state
1. We have heard reports from a mix of High,
Intermediate and Low burden countries
2. Significant improvements in reported results
3. WHO targets are reported to be overall being met
4. Yet ongoing burden of disease is often reported as high
and trend of morbidity and mortality is ‘stagnant’
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Ageing population and access to illegal migrants
HIV-TB co-infection
MDR-TB levels rising in some countries
The performance of the private sector and general hospitals
is variable
Concern re care in the poor and vulnerable populations
Health sector infrastructure variable especially in districts
Funding and health workforce, although improved remains
an issue
TB Performance Indicators in the Western Pacific Region, 2004
“Strategic Plan to Stop TB in the Western Pacific 2006 – 2010”
Prevalance Rate
(/105)
Case detection
SS+ (%)
Treatment Success
(%)
Mortality Rate
(/105)
Australia
6
56
95
1
Cambodia
709
61
93
94
China
221
65
94
17
Hong Kong
77
72
78
6
Japan
39
62
76
4
Lao PDR
318
55
79
25
Malaysia
133
69
72
16
Mongolia
209
80
87
24
11
59
36
1
Papua New Guinea
448
31
58
42
Philippines
463
73
88
48
Republic of Korea
125
59
82
10
41
67
77
4
232
89
92
22
New Zealand
Singapore
Vietnam
TB Performance Indicators in the South East Asia Region, 2004
“National Tuberculosis Control Programs South East Asia Region”
Prevalance Rate
(/105)
Case detection
SS+ (%)
Treatment Success
(%)
Mortality Rate
(/105)
Indonesia
262
66
90
41
Thailand
218
73
74
20
Estimated WPR Burden from TB and
Trends
• Estimated 4 million cases of TB in WPR
– 2 million new cases
• Seven high burden countries account for >95%
– Cambodia, China, Lao PDR, Mongolia, PNG,
Philippines & Vietnam
• A decline of 15% in prevalence & 12% in
mortality between 2000-2004
– Annual average of 4% and 3% respectively
ACHIEVEMENTS
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In Leadership terms
In Strategic Planning
Implementation Strategy
Activities
Infrastructure building
Surveillance and Quality monitoring
WP Regional Goals & Targets
Regional Committee WPR, 2000
Goal:
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Reduce TB prevalence and mortality by 50% in
2010 compared with 2000
Intermediate Targets (towards this goal):
1. Detect 70% of estimated active cases
2. Treat successfully 85% of these cases
3. 100% DOTS coverage
Case Detection in WPR
• From < 40% to >70% overall in 5 years
• Achieved by:
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Developing a strategic approach, The Global Plan to Stop TB
Strengthening political commitment
Accelerating DOTS expansion in public facilities
Higher case detection success in many countries
TB care more available and accessible
Improving collaboration of health providers
– Increase in financing and other resources
Treatment Success
• Overall the percentage of registered new TB
patients completing anti TB treatment > 85%
for last 10 years
• 5 of the 7 high burden of TB countries are
achieving this target
Estimated numbers of new cases, 2005
Estimated number
of new TB cases
(all forms)
No estimate
0-999
1000-9999
10 000-99 999
100 000- 999 999
1 000 000 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 2006. All rights reserved
Will achieving WHO targets reduce the
notification rate?
The barriers
– Spread of HIV
– Accumulation of MDR-TB cases
– Insufficient access to high quality TB care for the poor and
vulnerable populations
– Sub-optimal TB management practices in growing private sector
– Lack of National guidelines & training materials
– Lack of human resources and their development
AND/OR
– the rising population numbers
– Incorrect targets for the desired outcome
Future Directions
• The current level of detection of 70% will not be sufficient
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Enhancing active case finding approaches
Enhancing lab capacity
New diagnostic tools
Sustaining established mechanisms - e.g. monitoring and supervision of
DOTS implementation
• MDR-TB and TB-HIV co-infection will slow the annual decline
• Conventional DOTS service delivery does not guarantee equitable
access to TB Services
– In some countries, the same standards of care received through NTP
service delivery are not met by general hospitals, private providers, and
for the homeless, drug users, migrants & prisoners
What have we learned from these
presentations?
• The current burden of disease remains large
• There are important Regional and Country
successes
• Some targets are being achieved but
• The targets have needed to be revised to achieve
the objects
• There are significant barriers
• Do we have systems in place to achieve these
targets?
Pre-Conference Workshop 1
National TB Control Program
Concluding remarks for the Workshop
Dr Ral Antic
Chair Scientific Committee IUATLD-APR
Australia