Publicação: 18 de dezembro de 2018
This is the sixteenth global report on tuberculosis (TB) published by WHO in a series that started in 1997.
It pro- vides a comprehensive and up-to-date assessment of the TB epidemic and progress in implementing and financ- ing TB prevention, care and control at global, regional and country levels using data reported by 198 countries that account for over 99% of the world’s TB cases.
The introductory chapter (Chapter 1) provides general background on TB as well as an explanation of global targets for TB control, the WHO’s Stop TB Strategy and the Stop TB Partnership’s Global Plan to Stop TB 2011–2015. The main findings and messages about the six major themes covered in the rest of the report are pro- vided below.
The burden of disease caused by TB (Chapter 2)
In 2010, there were 8.8 million (range, 8.5–9.2 million) incident cases of TB, 1.1 million (range, 0.9–1.2 mil- lion) deaths from TB among HIV-negative people and an additional 0.35 million (range, 0.32–0.39 million) deaths from HIV-associated TB.
Important new findings at the global level are:
Updates to estimates of disease burden follow the comple- tion of a series of consultations with 96 countries between 2009 and 2011, including China, India and 17 African countries in the past year, and much greater availability and use of direct measurements of TB mortality. Ongo- ing efforts to further improve measurement of TB cases and deaths under the umbrella of the WHO Global Task Force on TB Impact Measurement, including impressive progress on TB prevalence surveys and innovative work to strengthen surveillance, are summarized.
At country level, dramatic reductions in TB cases and deaths have been achieved in China. Between 1990 and 2010, prevalence rates were halved, mortality rates fell by almost 80% and TB incidence rates fell by 3.4% per year. Methods used to measure trends in disease burden in China – nationwide prevalence surveys, a sample vital registration system and a web-based case notification system – provide a model for many other countries.
Other results reinforce the findings of previous global reports:
Case notifications and treatment outcomes (Chapter 3)
In 2010, there were 5.7 million notifications of new and recurrent cases of TB, equivalent to 65% (range 63–68%) of the estimated number of incident cases in 2010. India and China accounted for 40% of the world’s notified cases of TB in 2010, Africa for a further 24% and the 22 high-TB burden countries (HBCs) for 82%. At global lev- el, the treatment success rate among new cases of smear- positive pulmonary TB was 87% in 2009.
Between 1995 and 2010, 55 million TB patients were treated in programmes that had adopted the DOTS/Stop TB Strategy, and 46 million were successfully treated. These treatments saved almost 7 million lives.
Alongside these achievements, diagnosis and appro- priate treatment of multidrug-resistant TB (MDR-TB) remain major challenges. Less than 5% of new and pre- viously treated TB patients were tested for MDR-TB in most countries in 2010. The reported number of patients enrolled on treatment has increased, reaching 46 000 in 2010. However, this was equivalent to only 16% of the 290 000 cases of MDR-TB estimated to exist among noti- fied TB patients in 2010.
Financing TB care and control (Chapter 4)
In 97 countries with 92% of the world’s TB cases for which trends can be assessed, funding from domestic and donor sources is expected to amount to US$ 4.4 bil- lion in 2012, up from US$ 3.5 billion in 2006. Most of this funding is being used to support diagnosis and treatment of drug-susceptible TB, although funding for MDR-TB is growing and expected to reach US$ 0.6 bil- lion in 2012. Countries report funding gaps amounting to almost US$ 1 billion in 2012.
Overall, domestic funding accounts for 86% of total funding, with the Global Fund accounting for 12% (82% of all international funding) and grants from other agencies for 2%, but striking contrasts between BRICS (Brazil, the Russian Federation, India, China and South Africa) and other countries are highlighted:
Most of the funding needed to scale up the treatment of MDR-TB towards the goal of universal access is needed in BRICS and other middle-income countries (MICs). If BRICS and other MICs fully finance the scale-up of treatment for MDR-TB from domestic sources, current levels of donor financing for MDR-TB would be almost sufficient to fund the scale-up of MDR-TB treatment in low-income countries.
Donor funding for TB is expected to reach US$ 0.6 bil- lion in 2012, a 50% increase compared with US$ 0.4 bil- lion in 2006, but far short of donor funding for malaria (US$ 1.8 billion in 2010) and HIV (US$ 6.9 billion in 2010).
The continued inadequacy of conventional laboratory capacity is also illustrated:
Overall, laboratory strengthening needs to be acceler- ated, as is currently happening in 27 countries through the EXPAND-TB project supported by UNITAID.
Impressive improvements in recent years notwithstand- ing, much more needs to be done to reach the Global Plan targets that all TB patients should be tested for HIV and that all TB patients living with HIV should be pro- vided with CPT and ART.