T.B END �GAME STRATEGY��BY� Maha Ahmed��DEMONSTRATOR AT COMMUNITY MEDICINE DEPARTMENT�
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�RATIONALE
�RATIONALE (CONT’)
OBJECTIVES
INTRODUCTION
T.B bacilli (Myocbacterium tuberculosis).
a) Man: Open cases T.B in resp. discharges.
b) Cattle: Tuberculous cattle (cough spray).
a) Human type
b) Bovine type
BURDEN OF TB
BURDEN OF TB CONT.
TB incidence in Egypt
���TB AND HIV COINFECTION
Among people with Latent TB Infection, HIV infection is the strongest known risk factor for progressing to TB disease.
TB speeds up the replication of HIV.
TB AND COVID19 �(WHO GLOBAL TB REPORT 2021)
disruptions to the provision of and access to TB diagnostic and treatment services.
So,
THE GLOBAL PLAN TO STOP TB
THE WORLD HEALTH ORGANIZATION (WHO) END TB STRATEGY
END TB STRATEGY
3
CHALLENGES
Cost
US$ 1.4 billion funding gap
per year for implementation of existing TB interventions. An additional gap of US$ 1.3 billion exists for research
inadequate care
3.6 million people with TB
are missed
by health systems every year and therefore may not get adequate care they need
TB/HIV response needs acceleration
Antiretroviral treatment, treatment of latent TB infection and other key interventions still need further scale-up
MDR-TB remains
a public health crisis
Only one in four MDR-TB cases detected and one in two cases cured
THE WORLD HEALTH ORGANIZATION (WHO) END TB STRATEGY
A WORLD FREE OF TB
(ZERO deaths, disease, and suffering due to TB )
End the global tuberculosis epidemic
TARGETS AND MILESTONES
90% Reduction in number of TB deaths
80% Reduction in TB incidence rate by 2030 ,compared with 2015(WHO, 2014).
95% Reduction in number of TB deaths
90% Reduction in TB incidence rate by 2030 ,compared with 2015(WHO, 2014).
STRATEGY
5
A WORLD FREE OF TB
ZERO deaths, disease, and suffering due to TB
END THE GLOBAL TB EPIDEMIC
* The United Nations Sustainable Development Goals (SDGs) include ending the TB epidemic by 2030 under Goal 3.
Reduction in number of TB deaths
compared with 2015 (%)
MILESTONES
2020 2025
SDG* END TB
20%
35%
0%
75%
50%
0%
2030 | 2035 |
90% | 95% |
80% | 90% |
0% | 0% |
TARGETS
Reduction in TB incidence rate
compared with 2015 (%)
TB-affected families facing catastrophic costs due to TB (%)
STEWARDSHIP
PILLAR1:�INTEGRATED, PATIENT- CENTRED CARE AND PREVENTION
A. Early diagnosis of TB including universal drug-susceptibility testing, and systematic screening of contacts and high-risk groups
B. Treatment of all people with TB including drug- resistant TB, and patient support
D. Preventive treatment of persons at high risk; and vaccination against TB
C. Collaborative TB/ HIV activities; and management of co- morbidities
PILLAR 1
�
1.Early detection of tuberculosis.
2. Scale up introduction of new diagnostics
3.Implement systematic screening for tuberculosis among high-risk groups.
A. Early diagnosis of tuberculosis
Pillar 1 cont.
�
1.Early detection of tuberculosis.
2. Scale up introduction of new diagnostics
3.Implement systematic screening for tuberculosis among high-risk groups.
A. Early diagnosis of tuberculosis cont.
Wide introduction of new molecular diagnostic testing platforms will allow
�
1.Early detection of tuberculosis.
2. Scale up introduction of new diagnostics
3.Implement systematic screening for tuberculosis among high-risk groups.
A. Early diagnosis of tuberculosis cont.
Mapping of high-risk groups and carefully planned systematic screening for active disease among them may improve early case detection
������B. Treatment of all people with TB including drug- resistant TB, and patient support
Globally, Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. Only about one in three people with drug resistant TB accessed treatment in 2020 (WHO, 2021).
Pillar 1 cont.
B. Treatment of all people with TB including drug- resistant TB, and patient support cont.
1. Ambulatory services should be given preference over hospitalization.
2. New safer, affordable and more effective medicines
3.Allowing treatment regimens that are shorter in duration and easier to administer are key to improving treatment outcomes.
C. Collaborative TB/ HIV activities; and management of co-morbidities
(WHO TB/HIV POLICY)
Pillar 1 cont.
�
1. Collaboration between TB and HIV programs.
2. Decrease burden of TB in patient living with HIV
3. Decrease burden of HIV in patient with TB
WHO TB/HIV POLICY
Creation of national plan including TB/HIV patient supporting groups.
Development and implantation of the plan.
HIV surveillance among TB patient.
Monitoring and evaluation of activities.
Pillar 1 cont.
�
1. Collaboration between TB and HIV programs.
2. Decrease burden of TB in patient living with HIV
3. Decrease burden of HIV in patient with TB
WHO TB/HIV POLICY
Pillar 1 cont.
�
1. Collaboration between TB and HIV programs.
2. Decrease burden of TB in patient living with HIV
3. Decrease burden of HIV in patient with TB
WHO TB/HIV POLICY
HIV testing and prevention for TB patients
Antiretroviral ttt for TB pt with HIV
Pillar 1 cont.
D. Preventive treatment of persons at high risk; and vaccination against TB
1. Expand preventive treatment of people with a high risk of tuberculosis.
Isoniazid preventive therapy is currently recommended for the treatment of latent tuberculosis infection among people living with HIV and children under five years of age who are contacts of patients with tuberculosis.
2. Continue BCG vaccination in high-prevalence countries.
��BOLD POLICIES AND SUPPORTIVE SYSTEMS
PILLAR 2
PILLAR 2
9
A. Political commitment with adequate resources for TB care and prevention
D. Social protection, poverty alleviation and actions on other determinants of TB
B. Engagement of communities, civil society organizations, and all public and private care providers
C. Universal health coverage policy, and regulatory frameworks for case notification, vital registration, quality and rational use of medicines, and infection control
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INTENSIFIED RESEARCH AND INNOVATION
A. Discovery, development and rapid uptake of new tools, interventions and strategies
B. Research to optimize implementation and impact; and promote innovations
This pillar on research is critical to break the trajectory of the epidemic and reach the global targets.
PILLAR 3
PILLAR3
10
A. Discovery, development and rapid uptake of new tools, interventions and strategies
B. Research to optimize implementation and impact; and promote innovations
ACTIONS TO IMPACT
Rate per 100,000/year
100
Optimize use of current & new tools emerging from pipeline, pursue universal health coverage and social protection
Introduce new tools:
a vaccine, new drugs & treatment regimens for treatment of active TB disease and latent TB infection, and a point-of- care test
Current global trend: -1.5%/year
-10%/year by 2025
-17%/year
-5%/year
75
50
2015
2020
2025
2030
2035
25
10
11
Getting to the 2025 targets requires effective use of existing tools to combat TB, complemented by universal health coverage and social protection to:
Moving forward to the 2035 targets requires the ensured availability of new tools from the research, in particular:
Desired decline in global TB incidence rates to reach the 2035 targets
�MEASURING PROGRESS
MEASURING PROGRESS (GLOBAL PRIORITY INDICATORS)
. To assess and facilitate progress towards the targets,
. monitoring the implementation of the End TB Strategy
Number of people that developed TB, and were notified and treated, out
of the total estimated number of incident cases in the same year (%).
≥ 90%
2- TB treatment success rate
Number of TB patients who were successfully treated out of all notified TB
cases (%).
≥ 90%
3- Preventive treatment coverage
Number of people living with HIV and children who are contacts of cases who
were started on preventive treatment for latent TB infection, out of all those eligible (%).
≥ 90%
4- TB affected households facing
catastrophic costs
Number of TB patients and their households that experienced catastrophic
costs due to TB, out of all TB patients (%)
0%
5- Uptake of new diagnostics and new
drugs
Number of TB patients who were diagnosed using WHO-recommended rapid
tests, out of all TB patients (%).
Number of TB patients who were treated with regimens including new TB drugs,
out of those eligible for treatment with such drugs (%).
≥ 90%
KEY GLOBAL INDICATORS FOR THE POST-2015 GLOBAL TUBERCULOSIS STRATEGY
KEY GLOBAL INDICATORS FOR THE POST-2015 GLOBAL TUBERCULOSIS STRATEGY
EGYPT - SITUATION OF TUBERCULOSIS
EGYPT - SITUATION OF TUBERCULOSIS
Incidence of TB of Egypt fell gradually from 25 cases per 100,000 people in 2001 to 11 cases per 100,000 people in 2020.
No of cases
EGYPT SUCCESS STORIES
2. Egypt was classified as one of the 36 worldwide countries have achieved the global targets in both case detection and treatment success in year 2007.
3. The case detection rate of positive cases in Egypt was 72% (global target is 70%) and treatment success rate was 87% (global target is 85%).�Moreover, Egypt didn’t stand on this, but keep stepping ahead on the target of disease eradication to achieve 78% case detection and 89% treatment success in 2008.
NTP Egypt has been conducted a training course under title of (Toward TB Elimination) for EMR countries in collaboration with JICA
NATIONAL TUBERCULOSIS CONTROL PROGRAM – EGYPT (NTP)
NATIONAL TUBERCULOSIS CONTROL PROGRAM – EGYPT (NTP)
reduce the prevalence of tuberculosis in the community as quick as possible
This will be achieved through:
1. We see the NTP as a data reference source both nationally and internationally.
2. Expanding our research activities to all fields of TB control and utilizing the results of our research in improving our performance�
3. To develop a center for national and international conferences
REFERENCES
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