U. S. Senate Briefing World TB Day Celine Gounder, MD, ScM Center for TB Research, Johns Hopkins...
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Transcript of U. S. Senate Briefing World TB Day Celine Gounder, MD, ScM Center for TB Research, Johns Hopkins...
U. S. Senate Briefing World TB Day
Celine Gounder, MD, ScMCenter for TB Research, Johns Hopkins University
Director for Delivery, CREATE
On behalf of the IDSA/HIVMA Center for Global Health Policy
Epidemiology
• 9.4 million new cases of TB in 2008.• 1.3 million people died from TB in 2008.• TB is the #1 cause of death among HIV-
infected persons.• 1/3 of AIDS-related deaths are due to TB.• Over 2,000 people in Africa die from TB per
day.
Estimated incidence of TB (per 100,000 population per year) 2008
Malawi
• Funding from USG:– PEPFAR FY 2008: $23.9 million
• Including support from CDC for laboratory strengthening
– USAID FY 2008: $1.3 million– Global Fund disbursements to date for TB, HIV and HSS
:• $2.8 million for TB• $21.3 million for Health Systems Strengthening• $248 million for HIV• Total $272.1
– U.S. Contributions :1/3 or $81.7 million
Community sputum collection points
Project Hope sites in Mulanje, Malawi
Specimen transport
Sputum smear microscopy
Scaling up of sputum smear microscopy is supported by USAID’s TB CAP.
SWAp: Sector Wide Approaches
Information systems and evaluation
Information systems and evaluation
Baobab Health
Reference: World Health Report 2006.
Limits to task shifting
Doctors trained in sub-Saharan Africa working in OECD countries
Reference: World Health Report 2006.
TB is a women’s health issue.• Reductionist view of women’s health
= reproductive and maternal health• Tuberculosis is a leading killer of women.
– 700,000 women died from TB in 2008.– 536,000 women died from maternal causes in 2005.– Third leading cause of death among women ages 15-44.– Feminization of the HIV epidemic higher burden of TB in women– More among women than men despite low burden of HIV:
• Afghanistan• Pakistan
• To better serve women, TB should be integrated with HIV, antenatal, reproductive health, family planning and STI treatment services.
References: WHO 2009 Women and TB fact sheet.Maternal mortality in 2005. World Health Organization, Geneva, 2007.
Integration of TB with PMTCTin Soweto, South Africa
• 3,970 pregnant women were screened for TB at ANC clinics between 12/08 to 8/09
• 36% HIV-infected• TB prevalence– HIV-infected: 696 per 100,000– HIV-uninfected: 200 per 100,000
Reference: Gounder et al. CROI 2010. Session 180, Abstract 900.
Global GoalsIndicator Stop TB Targets
for 2007Progress by 2007
% of SSM+ TB detected 68% for 2007, 78% for 2010
63%
% of all TB detected 70% 56%
% SSM+ TB cured 85% 78% DOTS(23% non-DOTS)
# TB cases worldwide(prevalence)
7.8 million by 2015
13.7 million
# TB deaths worldwide 750,000 by 2015 1.8 million
% TB patients tested for HIV 56% for 2007 16%
# TB/HIV patients receiving co-trimoxazole 600,000 200,000
% TB/HIV patients receiving ART 30% 34%
% HIV patients screened for TB 72% 2.2%
#HIV patients receiving isoniazid preventive therapy 1.5 million 30,000
Reference: WHO Global TB Control Report 2009. WHO Stop TB. The Global Plan to Stop TB -- 2006-2015. 2006.
GHI Consultation Document not Consistent with Lantos-Hyde Targets
Indicator Lantos-Hyde Target 2009-2013
GHI Targets 2009-2014
# new TB patients receiving treatment 4.5 million 2.6 million
# new MDR patients diagnosed, receiving treatment 90,000 57,200
Particularly poor delivery of TB-related interventions by HIV programs
• TB screening results in earlier detection of TB:– ↓ morbidity and mortality attributable to TB– ↓ duration of infectiousness– ↓ transmission of TB (and thus also part of infection control)
• Isoniazid preventive therapy– 50-70% reduction in mortality– Reduces risk of TB among both patients receiving and not
receiving ART• Infection control
– Administrative controls: triage, cough hygiene, reduce time spent in health facilities, occupational health
– Environmental controls: ventilation, UV germicidal irradiation– Personal protective equipment
References: Innes C. CROI TB/HIV Satellite Session. 2/16/2010. Samandari T. CROI TB/HIV Satellite Session. 2/16/2010. Golub JE et al. AIDS. 2009;23:631-6. Golub JE et al. AIDS. 2007;21:1441-8.
USG funding for Global HIV/AIDS and TB(millions of dollars)
FY 2009 Enacted
ObamaFY 2010
FY 2010 Enacted
ObamaFY 2011
% Change FY 2010 to
Proposed FY 2011
Requests from
Global Health
Coalitions
IOM Recommendation
by 2012
Global AIDS $5,159 $5,259 $5,359 $5,500 2.6% $7,250 $7,800*
Global Fund
$600 $900 $1,050 $1,000 -4.7% $1,750
USAID TB $163 $173 $225 $230 2.2% $650 $800
PEPFARTB-HIV**
$150 -- $160 -- -- -- --
CDC TB $143 $144 $144 $143 -7% $220 --
NIH TB $189 -- $226 $215 -4.8% $320 --
*Combined bilateral Global AIDS and Global Fund spending. Reference: Institute of Medicine. Recommendations for the U.S. Government. May 2009.** TB-HIV funding portions of PEPFAR, not additional.
Thanks to…
• Sen. Sherrod Brown• Sen. Barbara Boxer• Sen. Johnny Isakson• Sen. Dick Durbin• Sen. Robert Casey
• Sen. Frank Lautenberg• Sen. Benjamin Cardin• Sen. Kirsten Gillibrand• Sen. Edward Kaufman