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Updates on TB/HIV burden
WHO European Region
2015 data
18th Wolfheze workshops / 15th NTP managers meeting,
31 May – 02 June 2017
Dr Andrei DADU
Technical officer,
Joint TB, HIV/AIDS and Hepatitis Programme
HIV AND TB REMAIN A DEADLY SYNERGY
CHALLENGES:© Maxim Dondiuk http://maximdondyuk.com/projects/tb-epidemic-in-ukraine
3,6
0,540
1
2
3
4
5
6
7
8
9
10
2000 2005 2010 2015
Rat
e p
er 1
00
00
0 p
op
ula
tio
n
Estimated TB/HIV mortality rate Estimated TB mortality rate
3.6% annual increase
between 2010-2015
-8.3% annual decline
between 2010-2015
Impressive decline in TB mortality combined with growing
burden of TB/HIV mortality
3
36
0
10
20
30
40
50
60
70
80
2000 2005 2010 2015
Rat
e p
er 1
00
00
0 p
op
ula
tio
n
Estimated TB/HIV rate Estimated TB incidence rate
-4.5% annual decline
between 2010-2015
WHO European Region has fastest decline in TB incidence,
however … still growing TB/HIV co-infection
6.2% annual increase
between 2010-2015
Main impact indicatorsTB and TB/HIV mortality, EUR, 2000-2015 TB and TB/HIV incidence, EUR, 2000-2015
Top 10 high TB/HIV countries;* Europe, 2015
RussiaUkraine
Uzbekistan (2010)
Portugal
Rep Moldova
Kazakhstan
Romania
United KingdomFrance
Spain
0
20
40
60
80
100
120
140
160
180
200
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75
Esti
mat
ed T
B in
cid
ence
per
10
0,0
00
po
pu
lati
on
Reported new HIV cases per 100,000 population
*10 TB/HIV high-burden countries estimated contributing to 90% of the total 27,000 TB/HIV new cases
9,00011,000
4
Source: Tuberculosis surveillance and monitoring in Europe 2017: ECDC / WHO Europe.
TB/HIV prevalence increased in most of HPCs
Countries with the higher TB/HIV co-
infection shows much faster
increase of HIV prevalence.
Estonia is only country showing
decline in HIV
Ukraine
Latvia
Estonia
Russia
Armenia
Moldova
Uzbekistan
Belarus
Lithuania
Kyrgyzstan
Georgia
Kazakhstan
Tajikistan
Romania
Azerbaijan
Turkey
Bulgaria
Turkmenistan
0,0 5,0 10,0 15,0 20,0 25,0HIV prevalence among TB patients (%)
20102015
HIV prevalence among TB patients in 2011 and 2015 in 18 HPCs of WHO European Region
HIV co-infection among TB patients continues to rise in Europe, 2015
5,56,1
7,8 8,0
9,071,3
77,985,9 88,9 88.0
0,0
2,0
4,0
6,0
8,0
10,0
0
20
40
60
80
100
2011 2012 2013 2014 2015
%%
HIV testing coverage and co-infection among TB patients in WHO European Region, 2011-2015
% HIV among TB cases % of known HIV status
Source: Tuberculosis surveillance and monitoring in Europe 2017: ECDC / WHO Europe. 22%17%
12%10%
9%9%
6%6%
4%3%
3%3%3%3%
2%1%
0%
9%9%
UkraineLatvia
EstoniaRussia
ArmeniaMoldova
UzbekistanBelarus
LithuaniaKyrgyzstan
GeorgiaKazakhstan
TajikistanRomania
AzerbaijanTurkey
BulgariaTurkmenistan
European…Subtotal 18 HPC
% HIV among TB patients, 18 HPC, 2015
HIV and TB create a deadly combination (cascade analysis)
88%
61%36% 41%
HIV testingcoverage
TB/HIV casedetection
ARV coverage treatment succes
HIV case detection among TB and ARV* treatment coverage , WHO European Region, 2015
* No data from RUS (40% of all TB/HIV detected cases) otherwise 62%
No data from RUS (30% of all TB/HIV on treatment)
CPT ?
Source: Tuberculosis surveillance and monitoring in Europe 2017: ECDC / WHO Europe.
• About 88% of known HIV status
• About 27 thousands estimated TB/HIV cases about
16.5 thousands (61%) were detected
• Of which only 5.8 thousands (35%)were offered antiretroviral treatment
• treatment success remain low = 41%
77
7
4
5
7
41
21
28
7
3
Success
Died (A6)
Failed
Lost-to-follow up
Not evaluated*
HIV negative
HIV positive
Treatment outcomes (%) of new and relapsed TB cases desegregated by HIV status
* Not evaluated: “transferred out”, “still on treatment”, others
TB treatment results by HIV status; WHO European Region
8
Source: WHO Europe / ECDC. Tuberculosis surveillance and monitoring in Europe 2017
New HIV infections; UNAIDS region, 2010-2015
UNAIDS. AIDS by the numbers 2016 (http://www.unaids.org/sites/default/files/media_asset/AIDS-by-the-numbers-2016_en.pdf)
New
HIV
infe
ctio
ns
in p
eop
le >
15
yea
rs (
/10
00
)
9
AIDS-indicative diseases; WHO Europe, 2015
ECDC/WHO Europe: HIV/AIDS surveillance in Europe 2015. Stockholm: ECDC, 2016
36%
20%
12%
10%
8%
3%
3%
3%
2%
2%
Pulmonary TB
Wasting syndrome
Extrapulmonary TB
Candidiasis (oesophagus)
Pneumocystis pneumonia
Encephalopathy
Pneumonia
Toxoplasmosis (brain)
Candidiasis (respiratory)
Isosporiasis
26%
21%
13%
9%
8%
7%
5%
5%
4%
3%
Wasting syndrome
Pulmonary TB
Pneumocystis pneumonia
Candidiasis (oesophagus)
Encephalopathy
Pneumonia
Toxoplasmosis (brain)
Kaposi sarcoma
Extrapulmonary TB
Cytomegalovirus
28%
15%
13%
10%
8%
7%
6%
6%
4%
3%
Pneumocystis pneumonia
Candidiasis (oesophagus)
Kaposi sarcoma
Wasting syndrome
Toxoplasmosis (brain)
Extrapulmonary TB
Cytomegalovirus
Pulmonary TB
Encephalopathy
Leukoencephalopathy
10
HIV cascade on TB prevention; WHO Europe, 2015
PLHIV = people living with HIV; IPT = isoniazid preventive therapy
Sources: ECDC/WHO Europe . Tuberculosis surveillance and monitoring in Europe 2017 (unpublished draft); https://extranet.who.int/tme/generateCSV.asp?ds=notifications
220,000
153,407
28,130 26,33510,037
0
20
40
60
80
100
Perc
enta
ge
10/53 countries reported(1/30 EU/EEA, 9/23 non-EU/EEA)
11
Collaborative framework for TB, HIV, VH
PLHIVPrisonersIDUMigrantsHealth workers
Mechanisms for integrated delivery
Coordinating body
Joint surveillance
Joint planning
Joint monitoring
Reduce the burden of TB
Case-finding
Prevention
Treatment
Infection control
Reduce the burden of HIV and VH
Testing and counselling
Prevention
Continuum of care
Treatment
Long-term facilities
MSMSex workersBlood transfusedMTCT
TB contactsSilicia exposureDiabetes mellitus
Alcohol harmful useTobacco smokingTransplantation hemodialysis
Heterosexual HIV contact
12
Towards integrated care (TB, HIV, IUD, hepatitis)
2012 2013 2014 20162015
13
TB action plan: activities related to HIV
1.B.3 WHO/partners, will help NTPs to develop strategies to maximize the
benefits of rapid diagnostic tools for hard-to-reach and vulnerable
populations (by 2017)
1.C.3 Member States (MS) will ensure the rational, safe and effective
introduction of TB medicines according to the most recent WHO policy
guidance (no later than 2016)
1.D.6 WHO/partners will assist MS in establishing coordination mechanisms at
national/regional levels to facilitate the delivery of integrated TB & HIV
services (by 2018).
1.D.2 MS will ensure that all TB patients have access to HIV counselling and
testing supported by national HIV and TB guidelines (no later than 2016).
1.D.3 MS will ensure that all TB/HIV patients have access to early and monitored
(as per most recent WHO recommendations) ART and CPT (no later than
2016).
TB and HIV action plans for WHO Europe 2016-2020
14
TB and HIV action plans for WHO Europe 2016-2020
HIV action plan: strategic direction related to TB
Strategic direction 3: Delivery for equity
Enabling environment and optimization of service delivery. Continuum of care also
relies on the integration with other services focusing on comorbidities and related
health conditions such as TB, MDR-TB and XDR-TB.
15
Acknowledgements: Member States
ECDC and WHO/HQ
RO and COs colleagues
https://twitter.com/WHO_Europe_TB