China Tuberculosis status and TB Control Strategy: China Tuberculosis status and TB Control Strategy Xiaomei Wang
Feb.8th, 2007 Beijing
Slide2: Tuberculosis not only is a public health problem, but also a serious social, economic and political issue
Slide3: 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
Slide4: 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
Slide5: 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
Slide6: 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
Slide7: One of the 22 high-burden countries, ranked in the second after India, accounted for 15% TB burden of the world China TB Epidemic
Slide8: 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
Slide9: 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
Slide10: 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
Slide11: 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
Slide12: 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
Slide13: 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
Slide14: 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
Slide15: 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
Slide16: 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
Slide17: Progress of China TB Control Progress of China TB Control( 2001－2005 )
Slide18: New smear positive cases detection rate from 1991 to 2005（%） Progress of China TB Control
Slide19: Cure rate of new smear positive cases in 1991-2005 Progress of China TB Control
Slide20: 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%
Slide21: 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
Slide24: 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
Slide25: 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
Slide26: 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
Slide28: 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
Slide29: 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
Slide30: 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
Slide31: 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
Slide32: 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
Slide33: 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
Slide34: "Innovate in operational research and development to promote new improved tools for a BETTER FUTURE" Research and Development
Slide35: Concluding Remarks
We have a global strategy, a global plan, and a global partnership
Together, let us Stop TB