TB in the SEA Region

Review Plans and ProgressDr Md Khurshid Alam Hyder

Medical Officer TB

SEARO/WHO

Western Pacif ic

Region

25%

Americas

4%

Eastern

M editerranean

Region

5%

European Region

4%

South-East Asia

Region

34%

African Region

28%

The SEA Region: 25% of the world’s people, but >33% of TB patients

4.8 million cases

538,000 deaths/year

Global Burden: 13.7 million TB cases; 2 million TB deaths

The numbers:The numbers:

Estimated number of

cases

Number on treatment as reported by

NTPs in 2008

>2.2 million>2.2 million4.88 million4.88 million

~ ~ 10001000> 150,000/yr> 150,000/yr

All forms of TB

Multidrug-resistant TB (MDR-TB)

Extensively drug-resistant TB (XDR-TB)

NANA <10<10

HIV-associated TB~~ 120, 000/yr120, 000/yr

~~ 6000 on 6000 on

ATT+ CPT +ARTATT+ CPT +ART

Adapted from a slide provided by Dr. Paul Nunn, WHO Geneva

Case detection and treatment success rates, SEAR countries, 1997 to 2007

50

55

60

65

70

75

80

85

90

95

100

0 10 20 30 40 50 60 70 80 90 100

Tre

atm

en

t s

uc

ce

ss

ra

te (%

)

Case detection rate (%)

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Target

zone

Source: Annual Reports on TB control, National TB Programmes, SEAR Member Countries, December 2008

CDR: 69%; TSR: 87%

0

2

4

6

8

10

12

14

16

18

20E

sta

blis

hed M

ark

et

Econom

ies

Centr

al E

uro

pe

Easte

rn E

uro

pe

Latin A

merica

Easte

rn

Mediterr

anean

Regio

n

Afr

ica low

HIV

incid

ence

Afr

ica h

igh H

IV

incid

ence

South

-east

Asia

Weste

rn P

acific

Regio

n

MD

R-T

B %

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

200,000

220,000

240,000

260,000

280,000

MD

R-T

B n

um

ber

% of MDR-TB

Number of MDR-TB

MDR TB Burden Among All Cases by Regions

28% of the global

burden of MDR-TB

Review of country plans and progress made

since last workshop in 2006

Bangladesh-Planned 2006

To establish a baseline

survey by 2009

Improve recording and

reporting system and compilation of data

SurveySurveillance

Bangladesh-Progress made

� Population based survey initiated in 2007 and preliminary results available

� Case notification rates increased steadily until 1997

� From 1998 till 2001, a flat or even falling pattern, while increase after 2001

� Increases due to improved case finding attributable to geographic expansion and intensified collaboration with NGOs. The observed variations are due to changes in case finding and not a true rise in incidence

� Soft ware for data collection and analysis developed

Bhutan-Planned 2006

ARTI survey by the end of

2007

To refine TB information

system by revising the current recording and

reporting system by 2007

SurveySurveillance

Bhutan-Progress made

� High notification of extra pulmonary TB

� Low number of smear negative TB

� Revision of recording and reporting system undertaken

DPR Korea-Planned 2006

ARTI surveys in three

province by 2010-2011

Revision of recording and

reporting forms and computerization at central,

provincial and county levels gradually

SurveySurveillance

DPR Korea-Progress made

� Recording and reporting forms revised

� Soft ware developed at the central level and

functional

� ARTI surveys conducted in three provinces in

2007; ARTI represents 3.1%

India-Planned 2006

�Prevalence surveys in six sites to be completed by 2010;

�Tuberculin testing baseline data information available by 2010

�National roll-out of EPIENTER to be completed by mid 2008;

�Enhancing data management capabilities at district/state/central levels;

�Training of trainers and planned roll-out of training;

�Electronic patient based information for DOTS-Plus cases

SurveySurveillance

India-Progress made

� Revised R&R and Windows based EpiCentre introduced late 2008 / DOS-based system to be phased out by end 2009

� On-going MIFA (Managing Information For Action) training of trainers course to enhance data management capabilities at district/state/

central levels since 2008

� Electronic patient based information for DOTS-Plus being developed

� Disease prevalence surveys on-going in seven sites, where screening is done through X-ray and symptom elicitation in 3 sites and with

symptom elicitation alone in 4 sites, followed by smear and culture field

enrollment expected to be completed by end 2009

� 2nd National ARTI survey on-going in 4 zones, field enrollment expected to be completed by March 2010

W1

Slide 18

W1 As decided upon by a National level Expert Committee. Also the Committee produced an estimate of the disease prevalence for the country for the year 2000.Waresf, 2009-07-17

Indonesia-Planned 2006

�Tuberculin survey in 3 epidemiological zones;

�TB mortality study in 6 provinces;

�TB/HIV sero-prevalence study in 6 provinces;

�Repeat national TB prevalence study in 2010

�Improvement of electronic TB software

�Inclusion of surveillance data, update provincial profiles and upload TB website

SurveySurveillance

Indonesia-Progress made

� 2004 TB Prevalence Survey show that the prevalence and incidence rates for Indonesia are 119 per 100,000 and 110 per 100,000 respectively

� National Institute for Health Research and Development (NIHRD-MOH) carried-out mortality survey in ten sub districts located in three main project sites representing metropolitan areas (Jakarta), urban areas (Surakarta) and rural areas (Pekalongan district), covering a total population of about 1 million, estimated to yield about 7000 deaths annually. The one year mortality data (2006) in Pekalongan district shows that TB was ranked as the sixth highest (6%) contributor for leading causes of death

Indonesia-Progress made

� HIV prevalence survey among TB patients in 5 provinces (Jakarta,West Java, East Java, Bali and Papua)

� Tuberculin Surveys in South Kalimantan and North Sulawesi Provinces of Indonesia to Estimate the Annual Risk of Tuberculosis Infection (ARTI), being implemented by University of Indonesia in collaboration with WHO

� Drug Resistance Survey in East Java Province is the second DRS in Indonesia using the same method with the first one in Central Java province done in 2006 is being conducted by NTP with support from KNCV, IMVS Australia and WHO

Maldives-Planned 2006

�Measure the duration of disease for better assessment of the prevalance

Set up of uniform excel format in the central office by 2008

SurveySurveillance

Maldives-Progress made

� Overall trend consistently downward across all age groups

� Rate of decline has decreased from 10% per year earlier to 1-2% currently

� Central uniform excel format in the process of development

Myanmar-Planned 2006

�Continuation of point prevalence survey in remaining parts of the country by 2008 and repeat in 2013-14

�Computerized recording and reporting system using STAR by 2007-08;

�Establish mortality data base system linked with existing vital registration by first quarter 2007

SurveySurveillance

Myanmar-Progress made

� Routine sentential surveillance among new TB patients are in place

� Results of TB prevalence survey in Yangon Division in 2006 showed incidence of TB 2.26 times higher than the current WHO estimates

� DHIS software were introduced in central, state and divisional levels

� Staff trained on data management

Nepal-Planned 2006

Mortality from observation on patient cohorts by 2008

Strengthening of data management system using EPICENTER by middle of 2007

SurveySurveillance

Nepal-Progress made

� Case notifications are rather flat following the period of DOTS expansion, which may signify that case finding is good but the incidence is apparently not decreasing

� Tuberculin survey was conducted, ARTI 0.6% indicating decrease in transmission or over estimation of previous estimates

� Sentinel surveys of HIV among TB patients conducted in 2006-07 show a prevalence of 2.4%

Sri Lanka-Planned 2006

�Tuberculin survey by 2007

�Drug resistant survey by 2010-11

Developing software on supervision, on going meetings, cross recording and reporting in TB/HIV

SurveySurveillance

Sri Lanka-Progress made

� Minimal change in over all case notification rates

� However, increase in the age group 15-24 years, particularly among males

� ARTI is on going and the preliminary results available by the end of July 2009

Thailand-Planned 2006

Not planned�Epidemiological situation analysis;

�Electronic recording and reporting system;

�Strengthening supervision, monitoring and evaluation in large hospitals by 2008

SurveySurveillance

Thailand-Progress made

� Epidemiological situation analysis done

� Electronic recording and reporting introduced in central level

� Supervision and monitoring strengthened in large hospitals

Timor Leste-Planned 2006

Not planned�Develop regional supervision and monitoring plan;

�Introduction of training on monitoring and evaluation;

�Quarterly reporting and follow up of new smear positive TB cases registered under DOTS successfully treated;

�Quality control by 2008

SurveySurveillance

Timor-Leste-Progress made

� In May 2008 based on analysis of national data and other evidence from Indonesia and in particular from province that includes West Timor, and active case finding data from one Sub-district in TLS revised range for incidence of NSP in the country 115 to 175 per100,000 population

� An updated excel format has been designed with assistance from WHO to recording national data at central level

� NTP data 2000-2008 organized into uniform excel format, retrospectively, prospective formats designed till 2012

� This allows internal consistency checks, auto generates a quarterly and annual performance report on key indicators, auto-generates relevant graphs, trend analysis

� Staff at NTP has been trained in the use of this new system

Thank you