1. The TB situation in the Americas: Reaching the MDGs on TB Dr. Jarbas Barbosa Area Manager, Health Surveillance & Disease Management 23 March 2007

2. Estimated TB Incidence Rates, 2005 No estimate 0–24 50–99 100–299 300 or more 25–49 Estimated New TB cases (all forms) per 100,000 inhabitants

3. Estimated TB Incidence Rates, 2005 Estimates Notifications Cases x 100.000 Source: Global Tuberculosis Control. WHO Report 2007.

4. Tuberculosis Notification Rates, 2005 Estimates Notifications Cases x 100.000 Source: Global Tuberculosis Control. WHO Report 2007.

5. Reported New TB Cases, Americas, 2005 80% Haiti Dom. Rep. MexicoHondurasEcuadorPeruBoliviaBrazilNicaraguaGuyanaColombiaGuatemala PeruBrazil 50% Total: 227.659 Source: Global Tuberculosis Control. WHO Report 2007.

6. Reported TB Incidence Rates, Americas, 2005 26 14 TBP BK+ TB all forms Cases per 100 000 hab. Source: Global Tuberculosis Control. WHO Report 2007.

7. DOTS Coverage, Americas, 2005 <50% ≥50-89% ≥ 90% without DOTS 2005 DOTS Coverage: 88% 88% of the population Source: Global Tuberculosis Control. WHO Report 2007.

8. Challenges in Tuberculosis Control: TB/HIV

9. HIV Prevalence in Adults in Latin America and the Caribbean, 1990−2005 Source: UNAIDS, 2006

10. Estimated HIV Prevalence in New TB Cases, 2005 No estimate 0–4 20–49 50 or more 5–19 HIV prevalence in TB cases, age 15–49 (%)

11. Countries in the American Region Testing Tuberculosis Patients for HIV, 2005 No reported activity < 15% 15% to 25% 25% to 50% More than 50% Proportion of TB Patients Tested for HIV: Key 5 = = 5 5 5 5 5 5 5 5 5 5 5 5 5 Countries with generalised HIV epidemic, 2004; HIV testing recommended for all TB patients Countries with a high estimated TB/HIV cases but not a generalized HIV epidemic

12. HIV Prevalence in Adult Patients with TB, Americas, 2005 WHO estimate Notified by countries Source: Global Tuberculosis Control. WHO Report 2007.

13. Challenges in Tuberculosis Control: MDR-TB and XDR-TB MDR-TB and XDR-TB

14. Prevalence of Initial MDR-TB, 1994–2005 0 - 0,9% 1,0 -1,9% 2,0 - 2,9% > 3% Source: WHO Report 2006. Global Tuberculosis Control

15. Countries Reporting at Least One Case of XDR-TB

16. Percentage of National TB Programs (NTPs) That Manage MDR-TB Patients as Part of Their Routine Activities, by WHO Region, 2005 Source: Global Tuberculosis Control. WHO Report 2007.

17. Will we reach the targets for global TB control? MILLENNIUM DEVELOPMENT GOALS: "to have halted and begun to reverse incidence.." Implementation (DOTS) Target year Case detection 70% 2005 Treatment success 85% 2004/5 Impact Prevalence 50% of ≈ 99/100K 2015 Deaths 50% of ≈ 10/100K 2015 Incidence <1 per million 2050

18. % year 65% 80% Did we Reach the 2005 targets? Source: Global Tuberculosis Control. WHO Report 2007.

19. Did we reach the 2005 targets? No, but…  65/70 + 80/85 = We are near  Incidence has begun to decrease  88% of the population live in DOTS areas  79% of the cases are notified under DOTS  Countries are implementing: the “Interim TB/HIV Policy” the GLC projects Plans to reach "neglected populations”  “STOP TB Partnerships” are being launched in the countries

20. Will we reach the Millennium Development Objectives by 2015?

21. Estimated TB Prevalence (a) and Death Rates (b), by WHO Region, for the MDG Baseline Year 1990, for 2005, and as Compared with the MDG Target for 2015 (a) TB prevalence rate per 100 000 population (b) TB death rate per 100 000 population Source: Global Tuberculosis Control. WHO Report 2007.

22. Will we reach the goals of the Millennium Objectives??Will we reach the goals of the Millennium Objectives?? YES, BUT ONLY IF…  The Global and Regional Plans become solid and financed national plans that implement the new “Stop TB Strategy”  There is intense Supervision and Monitoring to guide the actions and evaluate the impact.

24. Thank you