Burden of TB in SAARC

BURDEN OF TUBERCULOSIS IN SAARC REGION

SAARC Regional Strategy for Control / Elimination of Tuberculosis

SAARC has adopted WHO’s Global Stop TB Partnership strategy which envisions a TB-free world and elimination of TB by 2050.

Guiding Principles & SAARC TB Control Strategy

The strategic directions for TB Control are grounded in six principles, which will guide achievements of the strategic goals as follows:

Inclusiveness

Working in partnership with all stakeholders will be at the core of the TB Control Strategies in the SAARC Region. The stakeholders would include governments, private sector, non-governmental organization and civil society, researchers, academia, policymakers, professional bodies, national and international development agencies.

Equitable access to effective interventions

The TB Control strategy would endeavor to ensure equity in access, availability and utilization of the quality TB Control services for all sections of the population including poor and marginalized, special populations such tribal, people living in slums, and distant and inaccessible rural areas and terrains.

Flexibility

 All the SAARC Member States have their National Tuberculosis Programs and follow a general framework of DOTS and STOP TB partnership. However, each country may have specific and peculiar circumstances that would require adaptation of broad strategies to their own.

Quality

Commitment to high quality DOTS that would provide diagnostic services and treatment with effective anti-tubercular drugs will be an integral part of the strategy.

High Impact Interventions

High priority to research and innovation that have the greatest potential to improve and enhance performance and impact in reducing inequities, high cure rates, and contribute to achieving the Millennium Development Goals (MDGs) in the Region.

Ethics and Human Rights

Strategy would be based on the core values of equity, fairness and integrity, and promoting the utilization of scientific evidence and respect for gender and human rights.

Targets for SAARC Region

SAARC Region Targets for the scale-up of interventions for TB care and control set in line with the Global Plan to Stop TB 2011–2015.

  • By 2015: Reduce prevalence and death rates by 50%, compared with their levels in 1990.
  • By 2050: Reduce the global incidence of active TB cases to <1 case per 1 million population per year

SAARC Epidemiology

The SAARC region, with an estimated annual incidence of 3.1 million TB cases, carries 32% of the global burden of TB incidence. Four of the eight Member Countries in the Region are among the 22 high burden countries, with India accounting for 23 % of the world’s TB cases. Among 3.1 million incident TB cases, 2.1 million are notified new and relapse cases.

Estimates of the burden of diseases caused by TB in the SAARC Region 2014

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Incidence of TB

In 2014, there were an estimated 3.1 million incident cases of TB, equivalent to 185 cases per 100 000 population. This carries 31% of the global burden of TB incidence. The absolute number of incident cases is falling slowly, from 2000 to 2014. The incidence rate was relatively stable from 1990 up until around 2000, and then started to fall, achieving the MDG target far ahead of the 2015 deadline.

Prevalence of TB

There were an estimated 3.9 million prevalent cases of TB in 2014, equivalent to 230 cases per 100 000 population. At the end of 2014, the prevalence rate had met the target of a 50% reduction from 1990 levels.

TB Mortality

There were an estimated 0.37 million TB deaths in 2014. TB ranks alongside HIV as a leading cause of death from an infectious disease. India accounted for about one third of global TB deaths (both including and excluding those among HIV-positive people.

In the SAARC region, the mortality rate (excluding deaths among HIV positive people) had achieved the target of 50% reduction from 1990 levels

Notification, Case Detection and Treatment Success

A total 2.2 million cases were notified in 2014 in the SAARC region. The overall case detection rate in the region in 2014 for all types of TB cases was 63 % (53 to 89%) and treatment success rate of 89% (84 to 93%).

Table:Case detection (2014) and Treatment outcomes, New Smear – Positive cases (2013), SAARC Region

Presentation1

A remarkable progress has been made for DOTS since its inception in 1993 in the SAARC Region. By 1997 all Member States started DOTS strategy for TB control. DOTS coverage within the SAARC region has steadily increased since 2000. Population coverage in 1997 was 11%, since then it has increased and reached 99% in 2006 and since 2007 it is 100%. Regarding treatment success, the target was achieved in 2005. In 2014, case detection rate for all types of TB cases was 69%.

Chart: Progress in TB Control in SAARC Region, (2000-2014)

Untitled-2MDR – TB

The MDR TB cases in the region range from less than 1-4% among new TB cases and it ranges from less than one to almost 35 percent among the retreatment TB cases. In 2014 Pakistan has 4.3% of new tuberculosis cases with MDR-TB, which is highest in the SAARC region. However, in India there were 24,000 new MDR-TB cases among notified pulmonary TB cases. In case of retreatment Bhutan has 35% of new tuberculosis cases with MDR-TB, which is highest in the SAARC region. However, in India there were 47,000 MDR-TB cases among re treatment TB cases.

Table:Estimates of MDR-TB burden in the SAARC Region, 2014

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TB/HIV Co-infection

In 2014, almost 1 million TB patients with known HIV status has tested in which 44,707 (4%) tested TB patients are HIV-positive among them 92% and 90 % have started CPT and ART in the SAARC region. In the SAARC region, India accounts for highest TB patients with known HIV status followed by Pakistan and Afghanistan. Around 93% of HIV-positive TB patients started CPT and 90% started ART in India at the end of 2014. However Bangladesh, Bhutan and Pakistan have 100 % HIV-positive TB patients started ART. In 2014, Afghanistan, Nepal and Sri-Lanka have initiated HIV-positive people provided with IPT.

Table:HIV testing for TB patients, provision of CPT and ART to HIV-positive TB patients, and initiation of IPT for people newly enrolled in HIV care, 2014

Untitled-4The estimated population of SAARC region in year 2014 was 1.72 billion which 24% of global populations. In 2014, there were 3.1 million estimated incidence of TB cases, which carries 32% of global burden of TB diseases. However, the estimated prevalence of TB in the SAARC region was 3.9 million, which is 30% of global, also an estimated deaths due to TB in the region was 0.37 million, which is 33% of global deaths due to TB in year 2014.

Table: Global vs. SAARC Region on TB Indicators, 2014

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