The Disease Burden and Basics of

TB and DR-TB
 Session objectives
By the end of the session, participants will
• Describe the current global and national
TBL/DR-TB disease burden
• Discuss the basic science of TBL/DR-TB
• Understand the current implementation status
of TBL/DR-TB program
 TB pathogenesis and transmission
• Tuberculosis is a chronic infectious disease
• It is major cause of morbidity & mortality worldwide
• Tuberculosis (TB) is a disease caused by an organism called
Mycobacterium tuberculosis, a rod-shaped bacillus
• Mainly transmitted person-to-person by inhalation of infected
droplet nuclei, which are expelled into the air when an
untreated infectious pulmonary TB patient coughs or sneezes
• Rarely TB can be caused by M.bovis and M. Africanum and
other species of Mycobacterium
• Pulmonary TB is the most common type
4
 Natural history of TB

• In the majority of people, the immunological defense

either kills all the inhaled or ingested bacilli or keeps them
suppressed (silent focus) causing latent infection.
• Hence, under normal circumstances 10% of the infected will
develop active disease in their life time
• HIV positive people with latent TB infection has a 10%
annual and 50% lifetime risk of developing active TB disease.
• If untreated,
– TB leads to death within 5 years in at least half of the patients.
– Without treatment, about 20 to 25% could have natural healing
and
– 25 to 30% could remain chronically ill, thus continuing to spread
the disease in the community
 Who is at risk of TB?

• Persons living in the same household and those who are

in frequent and close contact with an infectious patient
• TB affects all people of age and sex.
• More vulnerable groups are those living in
- Low socio-economic condition,
- age less than 5 years,
- malnutrition,
- over-crowding and
- compromised immunity (e.g. HIV).
 Drug Resistance types
• Mono-drug resistance: resistance to one first-line anti-TB drug only.
• Poly-drug resistance: resistance to more than one first-line anti-TB drug
(other than both Isoniazid and Rifampicin).
• Multidrug resistance (MDR-TB): resistance to at least both Isoniazid and
Rifampicin.
• Extensive drug resistance (XDR-TB): resistance to any fluoroquinolone and to
at least one of three second-line injectable drugs (Capreomycin, Kanamycin
and Amikacin), in addition to multidrug resistance (- Isoniazid and
Rifampicin).
• Rifampicin resistance (RR-TB): resistance to Rifampicin detected using
phenotypic or genotypic methods, with or without resistance to other anti-TB
drugs. It includes any resistance to Rifampicin, whether mono-drug
resistance, multi-drug resistance, poly-drug resistance or extensive drug
resistance
Reasons for development of Drug Resistance

• Inadequate treatment causing direct or indirect

mono-therapy
• Person-to-person transmission of resistant strains

 Health care Related factors (Provider, Program

related factors)
 Drug related factors
 Patient related factors
Epidemiology _ Global TB report
 Cont…

Estimated TB incidence-
10.4 million
End TB strategy
% of MDR among new TB cases

Global Average=
3.9%(CI 2.7-5.1%)
% of MDR among previously treated TB
cases

Global Average= 21%

(CI 15-28%)
 National TB/DR-TB estimates
• Estimated Incidence: 192 per 100,000 population

• Prevalence estimate: 211 per 100,000 population

• Mortality rate(excludes HIV positives): 26 per 100,000

• HIV Co-infection rate among TB Patients: 11%

 Estimated DR-TB burden
• National DRS (2011-2014GC):
– 2.7 among New TB cases
– 17.8% among Previously treated TB cases
According to Global TB report
Estimated TB incidence, Ethiopia, 2015
Access to TB Diagnostic and Treatment Services
Access to TB Diagnostic
Services
• AFB Microscopy Services
– 3,081 HFs
• Gene Xpert Sites
– 140 HFs
• TB Culture Laboratories
– 8 Regional Reference labs
– 1 National reference Lab
Access to TB treatment services
• Government Hospitals - 156
• Public Health Centers - 3335
• Private HFs 359
• Health Posts - 10,013
• DR-TB TICs– 46
• DR-TB TFCs– 658
• PPM Sites: 359 (PPM-DOTS)
 DR-TB treatment providing centers
Region TIC TFC GeneXpert sites
Tigray 7 88 7
Amhara 9 182 21
Oromia 16 230 34 (35)
SNNPR 6 64 20
Addis Ababa 4 46 15 (16)
Dire Dawa 1 9 3
Harari 1 5 3
Benshingul G. (1) 2 2
Afar 1 20 4 (5)
Somali (1) 7 4
Gambella 1 5 2
EPHI, Federal & Uniformed -AA - 16 (19) – 8 viral load
HLs
National 48 658 137
Annual TB Cases Detection rate by Region, 2008
E.C
200
184
180

160

140
121
120 116
TB CDR

105
100

80 71 75 72
67 65
62
60 56
46 48
40

20

0
Tigray Afar Amhara Oromia Somali Ben Gum SNNPR Gambella Harar AA DD National
 Notified TB cases by Type , 2008 EFY

Retreatment cases
account 4% (4,921
cases)

Bacteriologically confirmed
4% New PTB
Clinically diagnosed New
P/Negative TB cases
35%
32% All forms of TB Clinically diagnosed New
cases notified EPTB cases
= 124,378
Retreatment

Ch
acc ildre
ou n <
30% nts 15
12 ye
.2% ars
cas
es
 MDR-TB enrollment
MDR/RR TB Patients started to SLD: 2001 -2008 EC

800
700
700 666

600 557
Number of Patients

500
397
400

300 271

200
110 112
100
7
0
2001 2002 2003 2004 2005 2006 2007 2008
 Treatment outcome of DR-TB
Treatment outcome of DR TB patients who has taken SLD for at least 24 months.

120

100.0
100
82.7
80 74.1 77.9 75.3
70.8 Cured
Completed
Percentage

60 Died
Failed
40 LTFU
Not
Evaluated
20
TSR

0
2003 2004 2005 2006 2007 2008
Reporting Year ,EFY
THANK YOU

24