Expansion of social protection is necessary towards zero catastrophic costs due to TB: The first national TB patient cost survey in the Philippines.

BACKGROUND: Tuberculosis (TB) is a disease associated with poverty. Moreover, a significant proportion of TB patients face a substantial financial burden before and during TB care. One of the top targets in the End TB strategy was to achieve zero catastrophic costs due to TB by 2020. To assess patient costs related to TB care and the proportion of TB-affected households that faced catastrophic costs, the Philippines National TB Programme (NTP) conducted a national TB patient cost survey in 2016-2017. METHODS: A cross-sectional survey of 1,912 TB patients taking treatment in health facilities engaged with the NTP. The sample consists of 786 drug-sensitive TB (DS-TB) patients in urban facilities, 806 DS-TB patients in rural facilities, and 320 drug-resistant TB (DR-TB) patients. Catastrophic cost due to TB is defined as total costs, consisting of direct medical and non-medical costs and indirect costs net of social assistance, exceeding 20% of annual household income. RESULTS: The overall mean total cost including pre- and post-diagnostic costs was US$601. The mean total cost was five times higher among DR-TB patients than DS-TB patients. Direct non-medical costs and income loss accounted for 42.7% and 40.4% of the total cost of TB, respectively. More than 40% of households had to rely on dissaving, taking loans, or selling their assets to cope with the costs. Overall, 42.4% (95% confidence interval (95% CI): 40.2-44.6) of TB-affected households faced catastrophic costs due to TB, and it was significantly higher among DR-TB patients (89.7%, 95%CI: 86.3-93.0). A TB enabler package, which 70% of DR-TB patients received, reduced catastrophic costs by 13.1 percentage points (89.7% to 76.6%) among DR-TB patients, but only by 0.4 percentage points (42.4% to 42.0%), overall. CONCLUSIONS: TB patients in the Philippines face a substantial financial burden due to TB despite free TB services provided by the National TB Programme. The TB enabler package mitigated catastrophic costs to some extent, but only for DR-TB patients. Enhancing the current social and welfare support through multisectoral collaboration is urgently required to achieve zero catastrophic costs due to TB.

Epidemiology and control of tuberculosis in the Western Pacific Region: update with 2013 case notification data.

INTRODUCTION: Since the year 2000, tuberculosis (TB) prevalence in the World Health Organization (WHO) Western Pacific Region decreased 36%. However, there were an estimated 1.6 million TB cases in the Region in 2013. This study describes a regional analysis using the WHO global TB database data from 2000 to 2013. METHODS: TB surveillance data are annually collected from 36 countries and areas in the Western Pacific Region using a web-based system. TB case notifications, treatment outcomes and information on TB/HIV coinfection are analysed descriptively. Stratified analysis of the TB data by age, sex and countries and areas were conducted. RESULTS: Countries and areas in the Western Pacific Region notified 1.3 million new and relapse TB cases in 2013. TB notification rate increased in the early 2000s, stabilized for several years and declined recently. Country-specific TB notification rates declined over time for all age groups in most countries. TB treatment success rates remain high in the Region with 16 countries reaching or maintaining 85% (or higher) in 2013. HIV testing among TB cases has increased gradually with approximately 11 000 HIV-positive TB cases diagnosed each year since 2009. DISCUSSION: The results suggest that true TB incidence is possibly declining. Treatment success rates have remained high for six of seven high-burden countries. TB surveillance data analysis is an important source of programmatic and epidemiological information. Careful interpretation of these findings can provide useful insight for programmatic decision-making. While the TB burden remains immense, national TB programmes must evolve and adapt to build upon previous efforts.

Epidemiology and control of tuberculosis in the Western Pacific Region: analysis of 2012 case notification data.

Tuberculosis (TB) control in the World Health Organization (WHO) Western Pacific Region has seen substantial progress in the last decade, with a 33% reduction in prevalent TB cases since 2000. The burden remains immense, however, and national TB programmes must evolve and adapt to build upon these gains. Through routine surveillance, countries and areas in the Region reported 1.4 million TB cases in 2012. The case notification rate increased in the early 2000s, appears to have stabilized in recent years and is in decline for all forms and new smear-positive cases. The age and sex breakdown for smear-positive TB case rates by country shows generally higher rates with increased age and declining rates over time for all age groups. Treatment success remains high in the Region, with 15 countries reaching or maintaining an 85% success rate. HIV testing among TB patients has increased gradually along with a slow decline in the number of HIV-positive patients found. The trend of TB notification is heavily influenced by programmatic improvements in many countries and rapidly changing demographics. It appears that cases are being found earlier as reflected in declining rates of smear-positive TB and steady rates of TB in all forms. WHO estimates depict a decline in TB incidence in the Region. HIV testing, while still low, has increased substantially in recent years, with essential TB/HIV services expanding in many countries. TB surveillance data, within inherent limitations, is an important source of programmatic and epidemiological information. Careful interpretation of these findings can provide useful insight for programmatic decision-making.

Drug-resistant tuberculosis in the WHO Western Pacific Region.

OBJECTIVE: To review the latest information about tuberculosis (TB) drug resistance and programmatic management of drug-resistant TB in the Western Pacific Region of the World Health Organization (WHO). METHODS: We analysed routine data reported by countries to WHO from 2007 to 2013, focusing on data from the following: surveillance and surveys of drug resistance, management of drug-resistant TB and financing related to multidrug-resistant TB (MDR-TB) management. RESULTS: In the Western Pacific Region, 4% (95% confidence interval [CI]: 3-6) of new and 22% (95% CI: 18-26) of previously treated TB cases were estimated to have MDR-TB; this means that in 2013, there were an estimated 71,000 (95% CI: 47,000-94,000) MDR-TB cases among notified pulmonary TB cases in this Region. The coverage of drug susceptibility testing (DST) among new and previously treated TB cases was 3% and 20%, respectively. In 2013, 11,153 cases were notified--16% of the estimated MDR-TB cases. Among the notified cases, 6926 or 62% were enrolled in treatment. Among all enrolled MDR-TB cases, 34% had second-line DST and of these, 13% were resistant to fluoroquinolones (FQ) and/or second-line injectable agents. The 2011 cohort of MDR-TB showed a 52% treatment success. Over the last five years, case notification and enrolment have increased more than five times, but the gap between notification and enrolment widened. DISCUSSION: The increasing trend in detection and enrolment of MDR-TB cases demonstrates readiness to scale up programmatic management of drug-resistant TB at the country level. However, considerable challenges remain.

Drug-resistant tuberculosis in the WHO Western Pacific Region

Objective:To review the latest information about tuberculosis (TB) drug resistance and programmatic management of drug-resistant TB in the Western Pacific Region of the World Health Organization (WHO).Methods:We analysed routine data reported by countries to WHO from 2007 to 2013, focusing on data from the following: surveillance and surveys of drug resistance, management of drug-resistant TB and financing related to multidrug-resistant TB (MDR-TB) management.Results:In the Western Pacific Region, 4% (95% confidence interval [CI]: 3–6) of new and 22% (95% CI: 18–26) of previously treated TB cases were estimated to have MDR-TB; this means that in 2013, there were an estimated 71 000 (95% CI: 47 000–94 000) MDR-TB cases among notified pulmonary TB cases in this Region. The coverage of drug susceptibility testing (DST) among new and previously treated TB cases was 3% and 20%, respectively. In 2013, 11 153 cases were notified—16% of the estimated MDR-TB cases. Among the notified cases, 6926 or 62% were enrolled in treatment. Among all enrolled MDR-TB cases, 34% had second-line DST and of these, 13% were resistant to fluoroquinolones (FQ) and/or second-line injectable agents. The 2011 cohort of MDR-TB showed a 52% treatment success. Over the last five years, case notification and enrolment have increased more than five times, but the gap between notification and enrolment widened.

Epidemiology and control of tuberculosis in the Western Pacific Region: analysis of 2012 case notification data

Tuberculosis (TB) control in the World Health Organization (WHO) Western Pacific Region has seen substantial progress in the last decade, with a 33% reduction in prevalent TB cases since 2000. The burden remains immense, however, and national TB programmes must evolve and adapt to build upon these gains. Through routine surveillance, countries and areas in the Region reported 1.4 million TB cases in 2012. The case notification rate increased in the early 2000s, appears to have stabilized in recent years and is in decline for all forms and new smear-positive cases. The age and sex breakdown for smear-positive TB case rates by country shows generally higher rates with increased age and declining rates over time for all age groups. Treatment success remains high in the Region, with 15 countries reaching or maintaining an 85% success rate. HIV testing among TB patients has increased gradually along with a slow decline in the number of HIV-positive patients found.The trend of TB notification is heavily influenced by programmatic improvements in many countries and rapidly changing demographics. It appears that cases are being found earlier as reflected in declining rates of smear-positive TB and steady rates of TB in all forms. WHO estimates depict a decline in TB incidence in the Region. HIV testing, while still low, has increased substantially in recent years, with essential TB/HIV services expanding in many countries.TB surveillance data, within inherent limitations, is an important source of programmatic and epidemiological information. Careful interpretation of these findings can provide useful insight for programmatic decision-making.