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China Tuberculosis status and TB Control Strategy: 

China Tuberculosis status and TB Control Strategy Xiaomei Wang Feb.8th, 2007 Beijing


Tuberculosis not only is a public health problem, but also a serious social, economic and political issue


one third of global population infected tubercle bacillus 8.5 million new cases each year  2 million people die of TB each year two third of patients are young, work force


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


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 MDR Latvia: 19% of MDR S Korea: 15% of MDR XDR found in Southern Africa associated with HIV


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


One of the 22 high-burden countries, ranked in the second after India, accounted for 15% TB burden of the world China TB Epidemic


High infecting rate Infecting rate was 44.5% in 2000, there are 550 million population was infected in China General population infecting situation 45% 55% infected Un-infected China TB Epidemic Nationwide TB epidemiological survey in 2000 showed


Epidemic situation is descending slowly, and the number of infectious patients almost has no decreasing. 涂阳患病率(1\10万) Estimated SS+ cases: 1990: 1.51 million 2000: 1.50 million Prevalence of SS+ is 122/100000 in 2000 Prevalence of active cases 367/100000 China TB Epidemic


Big difference between different regions The epidemic in rural area is nearly twice of that in urban area West region is 1.7 times as east region China TB Epidemic


Mortality of TB is decreasing stably, but which is still higher Mortality is 9.8/100000 in 1999,declined 53.9% compared with 1989年19.1/100000 in 1989,there are about 130000 patients die of TB every year China TB Epidemic


Global TB Control Strategy Global Importance Actions 1993:Global TB Emergency! 1998:Global Stop TB partnership 1999:West Pacific region TB crisis 2000:Amsterdam declare- Global TB Emergency! Not only a health problem 2001:Washington minister meeting-take actions 2000:Cairo meeting-promote DOTS expansion, mobilize support of international society 2001:Paris meeting-confirm the priority field of TB Control in 2002


Global TB Control Strategy Target of TB Control 50 days(by the end of 2001):finish developing NTP,launch Global against AIDS,TB and Malaria Fund 50 weeks(by the end of 2002): case detection rate reach 35%,set up ICC, Global Fund provide 1 million patients’ TB drugs 50 months(by the end of 2005): case detection rate and cure rate reach 70% and 85% respectively,develop measure for MDR and TB-HIV co-infection. Develop global plan for 2006-2010 50 years(by the end of 2050):dispel TB in the world


The five elements of DOTS Strategy Government commitment to TB control Case detection primarily by smear microscopy mostly on self-reporting symptomatic patients Standardised short-course chemotherapy under proper case management conditions, including DOT System of regular drug supply Efficient monitoring system for programme supervision and evaluation DOTS Strategy


State council held a videophone meeting on TB control Dec.21,2000,there were 47178 persons took part in the meeting. Vice premier, Li Lanqing, made an important speech China TB Control Strategy Government Actions


State council issued National TB control Program 2001-2010 on Oct. 13,2001 Central government disbursed 400 million for TB Control every year China TB Control Strategy Government Actions


Progress of China TB Control Progress of China TB Control( 2001-2005 )


New smear positive cases detection rate from 1991 to 2005(%) Progress of China TB Control


Cure rate of new smear positive cases in 1991-2005 Progress of China TB Control


Over 26 million patients treated under DOTS with high cure rates 0 10 20 30 40 50 60 70 80 90 100 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Case detection rate or cure rate (%) Target of CR 85% Target of CDR 70%


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

WHO-recommended Stop TB Strategy to Reach the 2015 MDGs: 

WHO-recommended Stop TB Strategy to Reach the 2015 MDGs Pursuing quality DOTS expansion and enhancement Additional components 2 Addressing TB/HIV and MDR-TB 3. Contributing to health system strengthening 4. Engaging all care providers 5. Empowering patients and communities 6. Enabling and promoting research

WHO-recommended Stop TB Strategy to Reach the 2015 MDGs: 

WHO-recommended Stop TB Strategy to Reach the 2015 MDGs Pursuing quality DOTS expansion and enhancement Additional components 2 Addressing TB/HIV and MDR-TB 3. Contributing to health system strengthening 4. Engaging all care providers 5. Empowering patients and communities 6. Enabling and promoting research


State council put TB control into the eleventh five plan State council held another videophone meeting on TB control in 2006, the vice premier, Wu Yi gave an important address MOH issued 2006-2010 Implementation Plan of “National Tuberculosis Control Programme (2001-2010) ” Central government increased financial input to TB control Developed new policies and guildlines on TB control New actions of China TB Control Stop TB strategy—to Reach MDGs


2006-2010 Implementation Plan of “National Tuberculosis Control Programme (2001-2010) ” Goal Leadership is strengthened and effective measures are adopted, in an effort to ensure the completion of all work targets contained in NTP, reduce tuberculosis (TB) cases and deaths, improve the healthy level of the whole population, and to promote the growth of society and economy in a coordinated way. Objective In the period of 2006-2010, two million infectious TB patients will be detected and treated; Smear positive TB prevalence and mortality rates are reduced by 50% by 2010 relative to 1990. New actions of China TB Control


Establish TB Control Service System TB Dispensary Hospitals Community Complete NTP using all kinds of resources Central government funds China Global Fund projects WB/DFID Project Local Government funds Damien Foundation Belgium Project Etc. Health Promotion Establish collaboration partnership NGOs Private sectors etc. New actions of China TB Control

Major Challenges for 2006-2010: 

Major Challenges for 2006-2010 Poor quality DOTS in some areas as a result of rapid DOTS expansion Maintaining or building political commitment of achieving 2010 target after reaching 2005 targets Improve access of DOTS service for all TB patients Tackling TB among migrant population, drug resistant TB and TB/HIV co-infection Insufficient human resource capacity to implement the Stop TB strategy Challenges for China TB Control


Round 1 Support NTP activities Round 4 Increase the case detection rate through collaboration between TB dispensary and hospitals Carry out health promotion by multi-sector cooperation Strengthen the human resource capacity building in central and provincial level Round 5 MDR-TB Migrant population TB/HIV co-infection Round 7 Encourage NGOs and other sectors’ participation China Global Fund TB programme


Biggest preventable cause of death from a single infection Major economic burden on patients and families Treatment cost-effective, even for TB-HIV and MDR-TB Global Plan to Stop TB: a clear and widely-supported plan of action to meet defined targets, based on a record of achievement Why Invest in TB Control


established in 2000 a global movement to accelerate social and political action to stop the spread of TB a network of international organizations, countries, donors (public and private sector), governmental and non-governmental organizations and individuals Partnership secretariat is housed in WHO The Global Partnership to Stop TB


What: A global social movement to Stop TB Need for multisectoral approach New opportunities to work in partnership Vision: A TB-free world Mission: Ensure that every TB patient has access to effective diagnosis, treatment and cure Stop transmission of TB Reduce the inequitable social and economic toll of TB Develop and implement new preventive, diagnostic and therapeutic tools and strategies to stop TB The Global Stop TB Partnership- Vision & Mission


by 2005: at least 70% of people with infectious TB will be diagnosed and at least 85% cured by 2015: the global burden of TB disease (prevalence and deaths) will be reduced by 50% relative to 1990 levels by 2050: the global incidence of TB disease will be less than 1 case per million population MDG 6 Target 8 to have halted by 2015, and begun to reverse the incidence" of TB The Global Stop TB Partnership- Target & MDG


New TB Drugs TB/HIV DOTS-Plus MDR-TB New TB Diagnostics DOTS expansion W O R K I N G G R O U P S New TB Vaccines Global Partners Forum Global TB Drug Facility Coordinating Board Partnership Secretariat WHO Technical Advisory Group Advisory Group on Resource Mobilisation Advocacy Comm Soc Mob The Stop TB Partnership- Governance and Structure


"Innovate in operational research and development to promote new improved tools for a BETTER FUTURE" Research and Development


Concluding Remarks We have a global strategy, a global plan, and a global partnership Together, let us Stop TB

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