EPIDEMIOLOGY OF TB
Dr Moyahabo Mabitsi
Overview
• Epidemiology of TB
• The TB epidemic In South Africa
• TB as a health problem
• Achieving the targets
Epidemiology
Globally, 2010:
¾ 8.8 million new cases of TB
‐ 13% of new TB infections in HIV infected patients
‐ 80% of total burden borne in 22 countries (WHO Report,2010) • 2‐billion people infected with M.TB (latent infection)
• 10% will progress to active TB disease
22 High Burden Countries
• Compared to 1990 level, Globally;
‐ Prevalence,
‐ Incidence,
‐ TB related deaths (WHO 2010 Report)
South Africa
South Africa
• 3rd highest in the world‐ burden of TB
• High Incidence of TB, 1% • High burden TB/HIV Co‐infected
• 0.4‐0.59 Million new cases of TB in 2010, • High burden DR‐TB
(WHO report,2010)
Estimated epidemiological burden of TB 2007 (WHO 2009 )
TB Incidence, per 100 000 Population (World Bank Data, 2010)
Burden Of TB By Province, (NDoH, 2010 Data)
Province
Proportion of
population
(%)
Proportion of
TB burden
(%)
21.3
Kwa Zulu Natal
30.5
13.5
Eastern Cape
15.4
22.4
Gauteng
14.2
10.4
Western Cape
12.3
6.4
North West
7.2
7.2
Mpumalanga
6.3
5.7
Free State
5.8
10.9
Limpopo
5.7
2.2
Northern Cape
2.3
Compared to 1990, South Africa…
(WHO Report 2010)
Why Is TB a problem
1. Mortality
Globally, 2010:
¾ 1.4 Million TB‐related deaths
‐ 24% were in HIV + patients
¾TB, second to HIV as single infectious cause of death
(WHO Report,2010) TB Deaths In SA, (Statistics SA)
Stats SA, Publication November 2011
Notified Cases of MDR‐TB, WHO 2010 Report
3. EMERGENCE OF DRUG‐RESISTANCE
4. Costs of TB Management
• Average cost of treatment for MDR‐TB
– 100 x the full cost of treating drug‐sensitive TB
– 25 x the annual cost of first‐line ART
Schnippel K, Rosen S, Kate,Shearer K Projected costs of Gene‐Xpert Roll‐out
• Projected total cost of TB diagnosis and treatment in 2011 under the accelerated Xpert scenario, • USD 293 million, • 35% more than the USD 218 million estimated as the total public‐sector TB budget for 2011 [1].
(Meyer‐Rath G, Schnippel K, Long L et al: Plos One; Cost of Gene‐Xpert in SA, May 2012, Volume 7, Issue 5)
Cost to Private Sector
•
TB diagnosis and treatment cost South Africa’s second largest medical scheme administrator (Metropolitan health) just under R146‐million in 2009, •
>100 000 claims being registered in KwaZulu‐Natal alone,
•
Gauteng showed the second highest incidence with 60 000 claims, •
Eastern and Western Cape third and fourth respectively, with under 20 000 claims. (Metropolitan Health Report,2010)
S. Naidoo, C. C. Jinabhai: INT J TUBERC LUNG DIS 2006, 10(6):676–682
5. TB IN HCW
Population Average
1%
Health Care Worker Average
2 %
Eastern Cape
2%
KZN
2%
Limpopo
1%
Mpumalanga
3%
North West
3%
Incidence of TB In HCW By Province, USAID TB Program SA, 2009
WHO & STOP TB Targets
Jassal M S , Bishai W R Clin Infect Dis. 2010;50:S156-S164
Achieving the targets
•ICF
•Infection Control
•IPT
•Strategies to promote adherence
•Patient & community education
•PPP
•Early diagnosis
•Better, rapid diagnostics
TB Prevention
TB diagnosis
Retention into care
TB, TB/HIV treatment
•Early initiation of TB treatment
•Early initiation of ART
•CPT prophylaxis
Thank You
“We can’t fight AIDS unless we do much more to fight TB as well”
NELSON MANDELA, BANGKOK, JULY 2004