Global tuberculosis control: a short update to the 2009 report

This report is a short update to the WHO report on global tuberculosis (TB) control that was published in March 2009, based on data collected from July to September 2009. It is designed to fill an 18-month gap between the full reports of 2009 (in March) and 2010 (in October), following changes to the production cycle of the report in 2009 that have been made to ensure that future reports in the series contain more up-to-date data.

The report includes the latest (2008) estimates of the global burden of TB (incidence, prevalence and mortality). It also includes an assessment of progress in implementing the Stop TB Strategy and the Global Plan to Stop TB, which in combination have set out what needs to be done to achieve the 2015 global targets for TB control. These targets are that incidence should be falling by 2015 (MDG Target 6.c) and that prevalence and mortality rates should be halved by 2015 compared with their level in 1990. The latest data (up to 2010) on financing for TB control are presented, and progress towards the 2015 targets at global and regional level is analysed. The report also features updates about the work of the Global Laboratory Initiative and the WHO Global Task Force on TB Impact Measurement, and highlights achievements in TB control during the period 1995–2008 as well as the success of a new initiative in 2009 in which global TB data collection went online.

In 2008, there were an estimated 8.9–9.9 million incident cases of TB, 9.6–13.3 million prevalent cases of TB, 1.1–1.7 million deaths from TB among HIV-negative people and an additional 0.45–0.62 million TB deaths among HIV-positive people (classified as HIV deaths in the International Statistical Classification of Diseases), with best estimates of 9.4 million, 11.1 million, 1.3 million and 0.52 million, respectively.

The number of notified cases of TB in 2008 was 5.7 million, equivalent to 55–67% of all incident cases, with a best estimate of 61% (10% less than the Global Plan milestone of a case detection rate of 71% in 2008). Among patients in the 2007 cohort, 87% were successfully treated; this is the first time that the target of 85% (first set in 1991) has been exceeded at global level. Progress in implementation of interventions to reduce the burden of TB in HIV-positive people has continued; in 2008, 22% of TB patients knew their HIV status (up from 20% in 2007) including 45% of patients in the African Region; 0.3 million people were enrolled on co-trimoxazole preventive therapy; and 0.1 million people were enrolled on antiretroviral therapy. Almost 30 000 cases of multidrug-resistant TB (MDR-TB) were notified in 2008; this is 11% of the total number of cases of MDR-TB estimated to exist among cases notified in 2008. Diagnosis and treatment of MDR-TB need to be rapidly expanded.

Funding for TB control has increased since 2002, and is expected to reach US$ 4.1 billion in 2010. Funding gaps remain, however; compared with the Global Plan, funding gaps amount to at least US$ 2.1 billion in 2010.

Globally, incidence rates peaked at 143 (range, 136–151) cases per 100 000 population in 2004. The world as a whole is on track to achieve MDG Target 6.c, as are eight of nine epidemiological subregions (the exception being African countries with a low prevalence of HIV). Five epidemiological subregions (Central Europe, Eastern Europe, high-income countries, Latin America and the Western Pacific) appear to have achieved the Stop TB Partnership target of halving the 1990 prevalence rate and four (Central Europe, high-income countries, Latin America and the Western Pacific) appear to have achieved the Stop TB Partnership target of halving the 1990 mortality rate, in advance of the target year of 2015. Prevalence and mortality rates are falling in all other regions with the exception of African countries with a low prevalence of HIV, although reaching the global target appears impossible in the African Region. Globally, the gulf between prevalence and mortality rates in 2008 and the target levels in African countries make it unlikely that 1990 prevalence and death rates will be halved by 2015 for the world as a whole.

Reductions in disease burden achieved to date follow fourteen years of intensive efforts at global, regional and country levels to implement the DOTS strategy (1995–2005) and its successor, the Stop TB Strategy (2006–). Between 1995 and 2008, a cumulative total of 36 million TB patients were successfully treated in DOTS programmes, and up to 8 million deaths were averted. To consolidate the major progress in global TB control achieved in recent years, intensified efforts to plan, finance and implement the range of interventions and approaches included in the Stop TB Strategy, according to the targets established in the Global Plan to Stop TB, are needed.