1. World TB Day 2000 Forging New Partnerships to Stop TB Produced by the [ Stop TB Initiative ] Coordinating Team: WHO

2. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 2 Leading infectious killers (1998 estimate) Estimated Deaths (millions) < 5 years old > 5 years old 0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 ARIAIDSDiarrhoeaTBMalariaMeasles

3. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 3 Magnitude of the TB Problem l 16–20 million prevalent TB cases globally l 8 million new TB cases annually l 2 million TB deaths annually (including TB-HIV) l TB is the biggest killer of people with HIV/AIDS l TB is the largest cause of death among women of reproductive age

4. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 4 TB - Where and Who 95% of new cases and 98% of deaths occur in developing countries —TB affects the poorest and most vulnerable 75% of TB infections and death occur in the 15–54 year age group —economically the most productive group in the population l 26% of avoidable deaths in developing countries are due to TB

5. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 5 DOTS Progress in 1998 l 43% of the global population had access to DOTS, double the fraction reported in 1995 l 119 countries have adopted DOTS—21% of global TB patients were treated under DOTS, double the fraction reported in 1995 l 220,000 additional cases of TB were reported globally compared with 1997

6. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 6 What is DOTS ? Directly Observed Treatment, Short-course (DOTS) has 5 key elements : l Government commitment to sustained TB control l Detection of infectious cases using sputum-smear microscopy l Standardized, short-course chemotherapy of 6 to 8 months with direct observation of treatment l Reliable supply of high quality drugs l Information systems for monitoring and recording of treatment outcome

7. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 7 AchievementsAchievements 199119951998 l Countries adopting DOTS 1070119 l TB patients under DOTS 1% 10% 21% l Average drug cost $40–60-$10–20 l External aid to TB $16 mil. - ~ $100mil.

8. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 8 Impact of TB on Families l A mother’s death significantly increases a child’s risk of dying l In India, 75% of urban and 67% of rural households went into debt l In India, 11% of children were withdrawn from school and 8% entered work. Around 300,000 children leave school every year due to TB l Each year in India, more than 100,000 women are rejected by their families

9. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 9 Economic Impacts of TB l A TB patient loses on average 3 to 4 months of work time l 20% to 30% of a TB patient’s annual household income is lost due to lost earnings l About 15 years of income are lost from premature death In South Africa, lost earnings due to TB are estimated at 16% of GDP per capita (Floyd et al., British Medical Journal, 1997) These substantial indirect costs borne by patients and their families are often greater than the direct treatment costs to the health sector

10. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 10 TB/HIV - The Dual Epidemic l Globally, 11 million people are currently infected with TB and HIV l HIV is responsible for 15% of all new cases of TB globally l In some African countries, 80% of TB patients also have HIV l TB is the single largest killer of people with HIV l TB treatment is equally effective in HIV+ and HIV- people. It increases their length and quality of life and benefits their families and communities

11. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 11 Multi-drug Resistance (MDR) TB l Poorly functioning TB programmes create MDR TB l DOTS prevents development of MDR TB l MDR TB has been identified in all continents l MDR TB treatment costs around 100 times more than treatment for non-MDR TB

12. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 12 Multi-drug Resistance (MDR) TB l MDR-TB is defined as the resistance to the two most important anti-TB drugs, Isoniazid and Rifampicin. l MDR-TB occurs when: -The wrong drugs or combination of drugs are prescribed -The right drugs are not taken consistently -The right drugs are not taken for the entire 6 months of treatment

13. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 13 Human Rights Violated l A cure for TB exists. Providing treatment for people with TB saves lives and protects their right to health. l TB patients and their families are often stigmatized and discriminated against l More than twice as many TB cases are reported in males than females due, in part, to gender differences in access to health l People with infectious TB infect on average 10–15 people every year just by breathing the air

14. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 14 TB impacts on Human Development TB deprives people of their right to the highest attainable standard of physical and mental health TB blocks peoples’ choices and traps them in a vicious cycle of poverty and disease

15. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 15 Household Coping Strategies l Selling productive assets reduces the economic prospects of the household l Removing children from school to help at home and save school fees seriously undermines their education and opportunities in life l Reducing intake of proper food increases the risk of contracting other diseases Diverting resources for TB from other health care needs further increases vulnerability to disease

16. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 16 DOTS: A Cost-effective Solution l Requires between US $ 1 and US $ 4 per discounted year of life saved (In low-income countries) l Could cut by 50% the current potential national economic loss from TB (Ahlburg, 1999) l Could lead to a US $ 55 return over 20 years for every dollar invested (Ahlburg, 1999 - Simulations for Indonesia)

17. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 17 Challenges ahead l How to expand DOTS coverage from 21% in 1998 to 70% by 2005? l How to sustain the targets once they are achieved? l How to ‘Build new Partnerships’ and link TB control to health sector and social development?

18. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 18 Forging new Partnerships... … to reach beyond the TB community and mobilize new constituencies affected by TB such as: l Women's organizations l Human rights groups l HIV/AIDS groups l Businesses

19. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 19 Forging new Partnerships l Why TB should matter to women's organizations  TB causes more deaths among women than all causes of maternal mortality combined  Over 900 million women are infected with TB world-wide, 1 million will die and 2.5 million will get sick this year from TB, mainly between the ages of 15 - 44.  There are many barriers for women to access health services. They are often unable to leave their family and work or need permission from their family. Many women lack the money for visiting the clinic or pay for treatment.  Women often end up carrying the burden of housework and their own sickness. By curing a women of TB, a life is saved and her husband and children are protected. Children suffer when the mother is sick and are at risk of contracting TB.  In many places, the stigma attached to TB leads to isolation, abandonment and divorce of women.

20. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 20 Forging new Partnerships l Why TB should matter to HIV/AIDS groups  TB is curable - TB treatment is as effective in HIV positive people as it is in HIV negative people  Curing TB can prolong the life and improve the quality of life of an HIV positive person, such as a young mother.  HIV/AIDS groups can encourage HIV positive people to get tested for TB and help HIV positive people complete their TB treatment  Curing TB in an HIV positive person protects other HIV positive people from contracting TB and reduces the risk of MDR TB  Respecting and promoting the right’s of people with TB and HIV and reducing stigma makes it easier for them to get informed and tested which can reduce the further spread of the infections

21. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 21 Forging new Partnerships Why TB should matter to Human rights groups  TB is curable - DOTS is an effective treatment strategy to cure TB.  Human rights groups can make information available about TB treatment, can lobby for access to affordable and effective treatment and encourage people to get tested and complete TB treatment.  Promoting and respecting human rights, including the rights of people with TB, is the prerequisite for health and development

22. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 22 Forging new Partnerships l Why TB should matter to businesses  75% of TB infections and death occur in the 15–54 year age group —economically the most productive group in the population  A TB patient loses on average 3 to 4 months of worktime  In Uganda, 80% of wage earners had to stop work because of their illness  TB is curable - DOTS is an effective treatment strategy to cure TB. People with TB, who receive treatment can continue their work. Businesses should encourage their employees to get tested and help employees with TB to complete their TB treatment.

23. Produced by the [ Stop TB Initiative ] — Coordinating Team: WHO 11/01/00 23 Regional Distribution of Tuberculosis in 1990, 1995 and 2000 Estimated TB cases in thousands (b) excludes Japan, Australia, New Zealand(a) excludes USA and Canada WHO