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
BURDEN OF TUBERCULOSIS IN SAARC REGION
SAARC Epidemiology
The SAARC region, with an estimated annual incidence of 3.7 million TB cases equivalent to 203 cases per 100 000, accounted for 37% of the global burden of TB incidence in the year 2019. Three of eight Member States in the SAARC Region are High TB and High MDR-TB burden countries among 30 High burden countries. India accounted for 26%, Pakistan 5.7% and Bangladesh 3.6% of the world’s TB Cases. An estimated 0.5 million (30 cases per 100 000) TB deaths occurred in the region in 2019.
Table 01: Estimates of TB Incidence in the SAARC Region 2019
| Country | Population (‘000) | Number | Rate* | ||
| Best Estimate | Uncertainty Interval (Range) | Best Estimate | Uncertainty Interval (Range) | ||
| Afghanistan | 38000 | 72000 | 46000-103000 | 189 | 122-270 |
| Bangladesh | 163000 | 361000 | 262000-474000 | 221 | 161-291 |
| Bhutan | 760 | 1300 | 960-1600 | 165 | 126-208 |
| India | 1366000 | 2640000 | 1800000-3630000 | 193 | 132-266 |
| Maldives | 530 | 190 | 150-240 | 36 | 28-46 |
| Nepal | 29000 | 68000 | 40000-103000 | 238 | 141-359 |
| Pakistan | 217000 | 570000 | 404000-764000 | 263 | 187-353 |
| Sri Lanka | 21000 | 14000 | 10000-18000 | 64 | 47-83 |
| Total | 1835290 | 3726490 | – | 203 | – |
Source: WHO Global Tuberculosis Report 2020, * Rates are per 100 000 population
Table 02: Estimates of the TB Mortality in the SAARC Region 2019
| Country | Population (‘000) | HIV -Negative TB Mortality | HIV-Positive TB Mortality | Total TB Mortality | |||
| Number | Rate * | Number | Rate * | Number | Rate * | ||
| Afghanistan | 38000 | 9800 | 26 | 120 | 0.32 | 9920 | 26 |
| Bangladesh | 163000 | 38000 | 24 | 150 | 0.09 | 38150 | 23 |
| Bhutan | 760 | 140 | 18 | 1 | 0.10 | 141 | 19 |
| India | 1366000 | 436000 | 32 | 9500 | 0.69 | 445500 | 33 |
| Maldives | 530 | 11 | 2 | 0 | 0.00 | 11 | 2 |
| Nepal | 29000 | 17000 | 58 | 220 | 0.77 | 17220 | 59 |
| Pakistan | 217000 | 42000 | 19 | 1900 | 0.90 | 43900 | 20 |
| Sri Lanka | 21000 | 770 | 3.6 | 4 | 0.02 | 774 | 4 |
| Total | 1835290 | 543721 | 30 | 11895 | 0.65 | 555616 | 30 |
Source: WHO Global Tuberculosis Report 2020, * Rates are per 100 000 population
In 2019, the SAARC region had 0.4 million estimated TB burden in children (0-14). Among them 0.24 million were males and 0.22 million were females. The region has 46% Children (age <5) house hold contacts of bacteriologically-confirmed TB cases on Isoniazid treatment (Table 03).
Table 03: Estimates of TB Burden in children (0-14) by age and sex in the SAARC Region, 2019
| Country | Male | Female | Total | Children (age <5) house hold contacts of bacteriologically -confirmed TB cases on preventative treatment (%) | |
| Afghanistan | 7800 | 7300 | 15100 | 93 | |
| Bangladesh | 17000 | 16000 | 33000 | 51 | |
| Bhutan | 32 | 30 | 62 | 28 | |
| India | 174000 | 160000 | 334000 | 33 | |
| Maldives | 1 | 2 | 3 | 70 | |
| Nepal | 2700 | 2400 | 5100 | 37 | |
| Pakistan | 40000 | 36000 | 76000 | 5.6 | |
| Sri Lanka | 410 | 370 | 780 | 51 | |
| Regional | 241943 | 222102 | 464045 | 46 |
Source: https://www.who.int/teams/global-tuberculosis-programme/data
3.2 Notifications and Treatment Success
A total 3.1 million TB cases were notified in 2019 in the SAARC region (Table 04). An increasing trend of total case notification has been shown in figure 01. The treatment success rate for new smear positive cases was 85% (2018 cohort) in the SAARC Region (Figure 02).
Table 04: TB Case notifications (2019) and Treatment Success Rate (2018 Cohort) in SAARC Region
| Country | Population (‘000) | Total Case notified | Total (New and relapse cases) | Treatment Success (%) | |
| Afghanistan | 38000 | 52770 | 52438 | 91 | |
| Bangladesh | 163000 | 292942 | 291595 | 94 | |
| Bhutan | 760 | 1016 | 1005 | 95 | |
| India | 1366000 | 2404815 | 2162323 | 82 | |
| Maldives | 530 | 154 | 154 | 64 | |
| Nepal | 29000 | 32043 | 31495 | 91 | |
| Pakistan | 217000 | 334754 | 328312 | 93 | |
| Sri Lanka | 21000 | 8434 | 8204 | 85 | |
| Total | 1835290 | 3126928 | 2875526 | 85 |
Source: WHO Global Tuberculosis Report 2020
Figure 01: Trend of total case notified in the SAARC Region (2010-2018)
Source: WHO Global Tuberculosis Report-2020, SAARC Epidemiological response on Tubreculosis-2019
Figure 02: Trend of Treatment success rate for new smear positive and relapse cases (2000-2018)
Source: WHO Global TB Report-2020, SAARC Epidemiological Response on Tuberculosis-2019
3.3 Drug Resistant TB
In the year 2019, the SAARC region had 157119 estimated MDR/RR-TB cases of among notified pulmonary TB cases. However, laboratory confirmed cases were 72677 MDR/RR-TB cases and 2625 XDR-TB cases. However, 61682 MDR/RR-TB and 1979 XDR-TB patients were started on treatment (Table 05).
Table 05: TB care services for Drug-resistant TB in the SAARC Region, 2019
| Country | Estimated MDR/RR-TB Incidence** | Laboratory Confirmed Cases** | Patients Started On Treatment | MDR/RR-TB Cases Tested For Resistance To Any Fluoroquinolone | |||
| MDR/RR-TB | XDR-TB | MDR/RR-TB | XDR-TB | ||||
| Afghanistan | 2400 | 486 | 5 | 396 | 6 | 43 | |
| Bangladesh | 3300 | 1373 | 7 | 1243 | 7 | 1248 | |
| Bhutan | 190 | 87 | 1 | 70 | 0 | 65 | |
| India | 124000 | 66255 | 2523 | 56569 | 1918 | 36748 | |
| Maldives | 2 | 1 | 0 | 1 | 0 | 1 | |
| Nepal | 2200 | 635 | 29 | 378 | 14 | 417 | |
| Pakistan | 25000 | 3820 | 60 | 3004 | 34 | 2512 | |
| Sri Lanka | 27 | 20 | 0 | 21 | 0 | – | |
| Regional | 157119 | 72677 | 2625 | 61682 | 1979 | 41034 | |
** Includes cases with unknown previous TB Treatment history
Source: WHO Global Tuberculosis Report 2020, *https://www.who.int/tb/country/data/download/en/
3.4 TB/HIV Co-infection
In 2019, the region had 47664 TB Patients with known HIV status, among them 45298 (95%) were on Antiretroviral Therapy. India accounts for 46741 TB patients with known HIV status, 95% patients were on ART, however, Bhutan and Sri Lanka had provided 100% ART to TB patients with Known HIV status in the region. (Table 06)
Table 06: TB/HIV care in new and relapse TB patients, 2019
| Country | Patients with known HIV status who are HIV positive | patients on Antiretroviral Therapy (ART) | ||
| Number | % | Number | % | |
| Afghanistan | 11 | 0.036 | 7 | 64 |
| Bangladesh | 120 | 1.2 | 116 | 97 |
| Bhutan | 3 | 0.31 | 3 | 100 |
| India | 46741 | 2.7 | 44517 | 95 |
| Maldives | 0 | 0 | 0 | – |
| Nepal | 159 | 0.72 | 155 | 97 |
| Pakistan | 624 | 0.48 | 494 | 79 |
| Sri Lanka | 6 | 0.078 | 6 | 100 |
| Regional | 47664 | 45298 | 95 | |
Source: WHO Global tuberculosis report 2020
The estimated Population of SAARC region in year 2019 was 1.83 billion which 24% of Global Population is. Table 07 shows the comparison between TB indicators for Global and SAARC Region respectively for the year 2019.
Table 07: Global vs. SAARC Region on TB Indicators, 2019
| TB Control Indicators | Global | SAARC | % of Global |
| Estimated Population | 7.69 billion | 1.83 billion | 24 |
| Estimated Incidence | 10 million | 3.7 million | 37 |
| (130 cases/100 000) | (203 cases/100 000) | ||
| Estimated Deaths Due to TB | 1.4 million | 0.5 million | 45 |
| Total cases notified | 7.5 million | 3.1 million | 41 |
| New and relapse notified cases | 7.1 million | 2.8 million | 39 |
| Treatment Success Rate (2018 cohort) | 85% | 85% | – |
| Estimated MDR/RR- TB incidence | 0.46 million | 0.15 million | 32 |
| Patients with Known HIV Status who are HIV Positive | 0.45 Million (9.5%) | 0.047 Million (5.52%) | 10 |
| Patients with Known HIV Status who are HIV Positive on ART | 0.39 Million (88%) | 0.045 Million (95%) | 12 |
Source: www.who.int/tb data/TB country, regional and global profiles (downloaded on 27 Jan 2021)