Global Tuberculosis Report. 2017
Published by HST
The purpose of WHO’s Global Tuberculosis Report is to provide a comprehensive and up-to-date assessment of the TB epidemic and of progress in care and prevention at global, regional and country levels.
This is done in the context of recommended global TB strategies and associated targets, and broader development goals. For the period 2016–2035, these are WHO’s End TB Strategy and the United Nations’ (UN) Sustainable Development Goals (SDGs), which share a common aim: to end the global TB epidemic. Specific targets set in the End TB Strategy include a 90% reduction in TB deaths and an 80% reduction in TB incidence (new cases per year) by 2030, compared with 2015. Achieving these targets requires provision of TB care and prevention within the broader context of universal health coverage, multisectoral action to address the social and economic determinants and consequences of TB, and technological breakthroughs by 2025 so that incidence can fall faster than rates achieved historically. Overall, the latest picture is one of a still high burden of disease, and progress that is not fast enough to reach targets or to make major headway in closing persistent gaps. TB is the ninth leading cause of death worldwide and the leading cause from a single infectious agent, ranking above HIV/AIDS.
In 2016, there were an estimated 1.3 million TB deaths among HIV-negative people (down from 1.7 million in 2000) and an additional 374 000 deaths among HIV-positive people. An estimated 10.4 million people fell ill with TB in 2016: 90% were adults, 65% were male, 10% were people living with HIV (74% in Africa) and 56% were in five countries: India, Indonesia, China, the Philippines and Pakistan.3 Drug-resistant TB is a continuing threat. In 2016, there were 600 000 new cases with resistance to rifampicin (RRTB), the most effective first-line drug, of which 490 000 had multidrug-resistant TB (MDR-TB).4 Almost half (47%) of these cases were in India, China and the Russian Federation. Globally, the TB mortality rate is falling at about 3% per year.
TB incidence is falling at about 2% per year and 16% of TB cases die from the disease; by 2020, these figures need to improve to 4–5% per year and 10%, respectively, to reach the first (2020) milestones of the End TB Strategy. Most deaths from TB could be prevented with early diagnosis and appropriate treatment. Millions of people are diagnosed and successfully treated for TB each year, averting millions of deaths (53 million 2000–2016), but there are still large gaps in detection and treatment.
In 2016, 6.3 million new cases of TB were reported (up from 6.1 million in 2015), equivalent to 61% of the estimated incidence of 10.4 million; the latest treatment outcome data show a global treatment success rate of 83%, similar to recent years. There were 476 774 reported cases of HIV-positive TB (46% of the estimated incidence), of whom 85% were on antiretroviral therapy (ART). A total of 129 689 people were started on treatment for drug-resistant TB, a small increase from 125 629 in 2015 but only 22% of the estimated incidence; treatment success remains low, at 54% globally. Making large inroads into these gaps requires progress in a particular subset of high TB burden countries. Ten countries accounted for 76% of the total gap between TB incidence and reported cases; the top three were India (25%), Indonesia (16%) and Nigeria (8%).5 Ten countries accounted for 75% of the incidence-treatment enrolment gap for drug-resistant TB; India and China accounted for 39% of the global gap.6 Most of the gaps related to HIV-associated TB were in the WHO African Region.
TB preventive treatment is expanding, especially in the two priority risk groups of people living with HIV and children under 5. However, most people eligible for TB preventive treatment are not accessing it. Financing for TB care and prevention has been increasing for more than 10 years, but funding gaps still exist (US$ 2.3 billion in 2017). Total health spending also falls short of the resources needed to achieve universal health coverage. Closing these gaps requires more resources from both domestic sources (especially in middle-income countries) and international donors (especially in low-income countries). Broader influences on the TB epidemic include levels of poverty, HIV infection, undernutrition and smoking. Most high TB burden countries have major challenges ahead to reach SDG targets related to these and other determinants. The pipelines for new diagnostics, drugs, treatment regimens and vaccines are progressing, but slowly. Increased investment in research and development is needed for there to be any chance of achieving the technological breakthroughs needed by 2025. The WHO Global Ministerial Conference on ending TB in the SDG era in November 2017 and the first UN General Assembly high-level meeting on TB in 2018 provide a historic opportunity to galvanize the political commitment needed to step up the battle against TB and put the world and individual countries on the path to ending the TB epidemic.
You can access the report here