The World Health Organization (WHO) has published an annual report on global control of tuberculosis (TB) every year since 1997. The main purpose of the report is to provide a comprehensive and up-to-date assessment of the TB epidemic and progress made in TB care and control at global, regional and country levels. Progress towards global targets set for 2015 is given particular attention. The target included in the Millennium Development Goals (MDGs) is that TB incidence should be falling by 2015. The Stop TB Partnership has set two additional targets, which are to halve rates of prevalence and mortality by 2015 compared with their levels in 1990. Collectively, the WHO’s Stop TB Strategy and the Stop TB Partnership’s Global Plan to Stop TB have set out how the 2015 targets can be achieved.
This fifteenth annual report1 contains more up-todate information than any previous report in the series, following earlier data collection and the completion of the production cycle within a calendar year.
The estimates of the global burden of disease caused by TB in 2009 are as follows: 9.4 million incident cases (range, 8.9 million–9.9 million), 14 million prevalent cases (range, 12 million–16 million), 1.3 million deaths among HIV-negative people (range, 1.2 million–1.5 million) and 0.38 million deaths among HIV-positive people (range, 0.32 million–0.45 million). Most cases were in the South-East Asia, African and Western Pacific regions (35%, 30% and 20%, respectively). An estimated 11–13% of incident cases were HIV-positive; the African Region accounted for approximately 80% of these cases.
There were 5.8 million notified cases of TB in 2009, equivalent to a case detection rate (CDR, defined as the proportion of incident cases that were notified) of 63% (range, 60–67%), up from 61% in 2008. Of the 2.6 million patients with sputum smear-positive pulmonary TB in the 2008 cohort, 86% were successfully treated.
New and compelling data from 15 countries show that efforts by national TB programmes (NTPs) to engage all care providers in TB control (termed public-private mix, or PPM) can be a particularly effective way to increase the CDR. In areas where PPM was implemented, non- NTP providers accounted for around one-fifth to onethird of total notifications in 2009.
In 2009, 26% of TB patients knew their HIV status (up from 22% in 2008), including 53% of patients in the African Region. A total of 300 000 HIV-positive TB patients were enrolled on co-trimoxazole preventive therapy, and almost 140 000 were enrolled on antiretroviral therapy (75% and 37% respectively of those who tested HIV-positive). To prevent TB, almost 80 000 people living with HIV were provided with isoniazid preventive therapy. This is an increase from previous years, but still represents less than 1% of the estimated number of people living with HIV worldwide.
Among TB patients notified in 2009, an estimated 250 000 (range, 230 000–270 000) had multidrugresistant TB (MDR-TB). Of these, slightly more than 30 000 (12%) were diagnosed with MDR-TB and notified. Diagnosis and treatment of MDR-TB need to be rapidly expanded.
Funding for TB control continues to increase and will reach almost US$ 5 billion in 2011. There is considerable variation in what countries spend on a per patient basis (US$ 1000), and the extent to which countries rely on domestic or external sources of funds. Compared with the funding requirements estimated in the Global Plan, the funding gap is approximately US$ 1 billion in 2011. Given the scale-up of interventions set out in the plan, this could increase to US$ 3 billion by 2015 without intensified efforts to mobilize more resources.
Incidence rates are falling globally and in five of WHO’s six regions (the exception is the South-East Asia Region, where the incidence rate is stable). If these trends are sustained, the MDG target will be achieved. Mortality rates at global level fell by around 35% between 1990 and 2009, and the target of a 50% reduction by 2015 could be achieved if the current rate of decline is sustained. At the regional level, the mortality target could be achieved in five of WHO’s six regions; the exception is the African Region (although rates of mortality are falling). Prevalence is falling globally and in all six WHO regions. The target of halving the 1990 prevalence rate by 2015 appears out of reach at global level, but could be
achieved in three of six regions: the Region of the Americas, the Eastern Mediterranean Region and the Western Pacific Region.
Reductions in the burden of disease achieved to date follow 15 years of intensive efforts to improve TB care and control. Between 1995 and 2009, a total of 41 million TB patients were successfully treated in DOTS programmes, and up to 6 million lives were saved including 2 million among women and children. Looking forwards, the Stop TB Partnership launched an updated version of the Global Plan to Stop TB in October 2010, for the years 2011–2015. In the five years that remain until the target year of 2015, intensified efforts are needed to plan, finance and implement the Stop TB Strategy, according to the updated targets included in this plan. This could save at least one million lives per year.