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3.3 TB treatment and treatment coverage

To minimize the ill health and mortality caused by TB, everyone who develops TB disease needs to be able to promptly access diagnosis and treatment. TB treatment coverage can be estimated as the number of new and relapse cases detected and treated in a given year, divided by the estimated number of incident TB cases in the same year, expressed as a percentage. People living with HIV who develop TB also require antiretroviral treatment (ART) for HIV, to avoid preventable deaths from TB and HIV.

Globally in 2021, TB treatment coverage (overall, for both HIV-negative and HIV-positive people) was 61% (95% uncertainty interval [UI]: 57–65%) (Fig. 3.3.1), up from 58% (95% UI: 54–61%) in 2020 but substantially lower than 69% (95% UI: 62–77%) in 2019.

Among the six WHO regions, treatment coverage was highest in the Region of the Americas (with a best estimate of 69%) and lowest in the Eastern Mediterranean (with a best estimate of 58%). Of the 30 high TB burden countries, those with the highest levels of treatment coverage in 2021 included Zambia, Uganda, Bangladesh, Brazil and China. However, the high estimate for Mozambique may reflect over-diagnosis of TB, with a very low proportion of reported cases diagnosed based on bacteriological confirmation (Section 3.2). Ten high TB burden countries had worryingly low levels of treatment coverage in 2021, with best estimates of below 50%: Central African the Republic, Gabon, Indonesia, Lesotho, Liberia, Mongolia, Myanmar, Nigeria, the Philippines and Viet Nam

Fig. 3.3.1 Estimated TB treatment coveragea in 2021, 30 high TB burden countries, b WHO regions and globally


a Notifications of people with a new or relapse episode of TB as a percentage of estimated incident TB cases.
b Incidence estimates for India are interim and subject to finalization, in consultation with the Health Ministry & Family Welfare, India.


Estimated treatment coverage is much lower among children than adults (Fig. 3.3.2). Globally in 2021, treatment coverage was 38% (95% UI: 36–42%) among children aged 0–14 years, compared with a best estimate of 63% among those aged 15 years and above.

Fig. 3.3.2 Estimated TB treatment coveragea among children aged 0–14 years and adults aged ≥15 years in 2021, 30 high TB burden countries b, WHO regions and globally


a Notifications of people with a new or relapse episode of TB as a percentage of estimated incident TB cases.
b Incidence estimates for India are interim and subject to finalization, in consultation with the Health Ministry & Family Welfare, India.


In 2021, ten countries accounted for 75% of the global gap between the estimated number of people who developed TB (incident TB cases) and the number of people who were detected with TB and officially reported (Fig. 3.3.3). About 60% of the global gap was accounted for by five countries: India (24%), Indonesia (13%), the Philippines (10%), Pakistan (6.6%) and Nigeria (6.3%).

Fig. 3.3.3 The ten countries with the largest gaps between notifications of people with a new or relapse episode of TB (incident cases) and the best estimates of TB incidence, 2021a,b

Bubble map of difference between notifications and estimated incidence for 10 countries
a The ten countries ranked in order of the size of the gap between notified cases and the best estimates of TB incidence in 2021 are: India, Indonesia, the Philippines, Pakistan, Nigeria, China, South Africa, Myanmar, Viet Nam and the Democratic Republic of the Congo.
b Incidence estimates for India are interim and subject to finalization, in consultation with the Health Ministry & Family Welfare, India.


Among people living with HIV who develop TB, both TB treatment and antiretroviral treatment (ART) for HIV are necessary to prevent unnecessary deaths from TB and HIV. Since 2019, the global coverage of ART for people newly diagnosed and reported with TB has been maintained at the level of 89% (Fig. 3.3.4). However, when compared with the estimated number of people living with HIV who developed TB in 2021, coverage was much lower, at 46%, the same level as in 2020). This was far below the overall coverage of ART for people living with HIV, which was 75% at the end of 2021 (6). The main reason for relatively low coverage was the big gap between the estimated number of people living with HIV who developed TB in 2021 and the number of people who were reported to have been diagnosed with TB in 2021.

Fig. 3.3.4 Estimated global number of incident cases of TB among people living with HIV (red) compared with the global number of people notified with a new or relapse episode of TB who were known to be HIV-positive (black) and the global number of TB patients who were started on antiretroviral therapy (blue), 2004–2021

The shaded area represents the 95% uncertainty interval.


Among the 30 high TB/HIV burden countries, best estimates of the coverage of ART among people living with HIV who developed TB in 2021 varied widely, from 9.4% in the Philippines to 81% in Uganda, and only 12 of these 30 countries achieved coverage of at least 50% (Fig. 3.3.5).

Fig. 3.3.5 Estimated coverage of antiretroviral therapy for people living with HIV who developed TBa in 2021, 30 high TB/HIV burden countries, b WHO regions and globally


a HIV-positive TB patients on antiretroviral therapy as a percentage of the estimated number of incident TB cases among people living with HIV.
b Incidence estimates for India are interim and subject to finalization, in consultation with the Health Ministry & Family Welfare, India.


Globally in 2020 (the latest annual patient cohort for which data are available), the treatment success rate for people treated for TB with first-line regimens was 86%, and ranged among WHO regions from 71% in the European Region to 92% in the Eastern Mediterranean Region ( Fig. 3.3.6).

Fig. 3.3.6 Treatment outcomes for people diagnosed with a new or relapse episode of TB in 2020, WHO regions and globally



Despite all the disruptions caused by the COVID-19 pandemic, the treatment success rate globally was the same in 2020 as in 2019 ( Fig. 3.3.7). This suggests that the quality of care for those diagnosed with TB and initiated on treatment was sustained despite all of the disruptions caused by the COVID-19 pandemic, a major collective achievement of many countries. Treatment success rates are still lower among people living with HIV, at 77% globally in 2020, although there have been steady improvements over time.

Fig. 3.3.7 Treatment outcomes for people diagnosed with a new or relapse episode of TB globally 2012–2020



Among WHO regions, the best treatment success rate among people living with HIV was achieved in the African Region, where the burden of HIV-associated TB is highest (Fig. 3.3.8).

Fig. 3.3.8 Treatment outcomes for people living with HIV who were diagnosed with a new or relapse episode of TB in 2020, WHO regions and globally



The treatment success rate for children (aged 0–14 years) was 88% in 2020 (Fig. 3.3.9).

Fig. 3.3.9 Treatment success rates for children aged 0–14 years who were diagnosed with a new or relapse episode of TB in 2020, WHO regions and globally a


a Data reported by 146 countries on outcomes for 301 713 children aged 0–14 years, equivalent to 76% of the 399 523 cases among children aged 0–14 years that were notified in 2020.


In combination, TB treatment and provision of ART to HIV-positive people diagnosed with TB are estimated to have averted 74 million deaths between 2000 and 2021 (Table 3.3.1).

Table 3.3.1 Cumulative number of deaths averted by TB and TB/HIV interventions 2000–2021 (in millions), globally and by WHO region


HIV-negative people
HIV-positive people
Total
WHO region Best estimate Uncertainty interval Best estimate Uncertainty interval Best estimate Uncertainty interval
African Region 7.1 6.0–8.3 8.5 7.2–9.8 16 14–17
Region of the Americas 1.9 1.8–2.1 0.36 0.33–0.39 2.3 2.1–2.4
South-East Asia Region 30 25–34 2.9 2.0–3.8 32 28–37
European Region 2.1 1.9–2.4 0.32 0.28–0.35 2.4 2.2–2.7
Eastern Mediterranean Region 5.2 4.6–5.8 0.10 0.077–0.12 5.3 4.7–5.9
Western Pacific Region 16 14–17 0.50 0.42–0.59 16 15–18
Global 62 54–68 13 11–14 74 67–81

Further country-specific details about TB treatment coverage and outcomes are available in the Global tuberculosis report app and country profiles.

Data shown on this webpage are as of 29 August 2022 (see Annex 2 of the main report for more details).

References

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  2. Guidelines on treatment of drug-susceptible tuberculosis and patient care (2017 update). Geneva: World Health Organization; 2017 (https://apps.who.int/iris/bitstream/handle/10665/255052/9789241550000-eng.pdf).

  3. WHO consolidated guidelines on tuberculosis, Module 4: Treatment – drug-resistant tuberculosis treatment. Geneva: World Health Organization; 2020 (https://www.who.int/publications/i/item/9789240007048).

  4. Implementing the End TB Strategy: the essentials (WHO/HTM/TB/2015.31). Geneva: World Health Organization; 2015 (https://www.who.int/tb/publications/2015/end_tb_essential.pdf).

  5. Sustainable development goals [website]. New York: United Nations ( https://sustainabledevelopment.un.org/topics/sustainabledevelopmentgoals).

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