La estrategia «Fin de la Tuberculosis»

Ernesto Jaramillo23 Noviembre, 2015

Barcelona

Reducción de 47% en mortalidad por TB desde 1990

1990 2000 2015

Blanco

Rate per 100,000population

Ref: Global TB Control Report 2015

Malaria = 7m

VIH = 7.8m

TB = 43m

43 millones de muertes por TB evitadas entre el 2000 y el 2014

1.5 millones de muertes por TB en el 2014

890,000 hombres / 480,000 mujeres /140,00 niños

estimadas y/o reportadas

2012, Observatorio de Salud Global OMS

En gris: muertes TB/HIV

Millones

2014, OMS y ONUSIDA

TB

HIV/AIDS

TB

HIV/AIDS

TB es junto a VIHuna causa principal de muerte

9.6 millones caen enfermos con TB en el 2014

5’4 m hombres / 3’2 m mujeres /1m niños

Casos de TB estimados y/o reportados

~3.6 millones estimados no son diagnosticados ni reportados

Ref: Global TB Control Report 2015

10 estados tienen

75% (2.7 millones) de los

casos “extraviados”

9.6 millones estimados

6 millones notificados

Incidencia de TB: países y regiones

Re

f: Glo

ba

l TB

Co

ntro

l Re

po

rt 20

15

Prevalencia estimada de VIH en casos nuevos de TB en 2014

74% de casos TB/HIVreportados en Africa

TB/VIH

Re

f: Glo

ba

l TB

Co

ntro

l Re

po

rt 20

15

Porcentaje de casos nuevos de TB con TB-MDR

Mayor parte en antigua URSS

India, China, Russia, Pakistan y Ucraniatienen 62% de todos los casos

TB-MDR: 3% de los casos nuevos de TB

Crisis de TB-MDR persiste

480 000

123 000

111 000

50%50%

Tres de los 27 paises con alta carga reportaron exito de

Tratamiento en ≥ 75%

cases of MDR-TB estimated in 2014

Invertir en respuesta a TB da alto rendimiento

Development - The economics of optimism , Jan 24th 2015 - The debate heats up about what goals the world should set itself for 2030

67ma Asamblea Mundial de la Salud, Ginebra,

Mayo 2014

Acelerar el declive de la incidencia, 1990-2035

“Todo

vale”

Estrategia

DOTS

Estrategia

Alto a la TBEstrategia Fin de la TB

Lo esencial!

Lo esencial en el contexto del

sistema de saludIntegrar

prevencion con tratamiento

Context global

METAS DE DESARROLLO SOSTENIBLE - META 3.3 INCLUYE

FIN DE LA EPIDEMIA DE TB EN EL 2030

41% declive desde 1990 45% declive desde 1990

blanco blanco

Incidencia Prevalencia Mortalidad

MDM lograda No se alcanzó Meta al alcance

Ra

te p

er

10

0,0

00

po

pu

lati

on

Source: WHO Global TB Report 2014

Metas de desarrollo del milenio en TB

(source: http://sustainabledevelopment.un.org/focussdgs.html)

Sustainable Development Goals 2016- 2030

Goal 1 End poverty in all its forms everywhere

Goal 2 End hunger, achieve food security and improved nutrition and promote sustainable agriculture

Goal 3 Ensure healthy lives and promote well-being for all at all ages

Goal 4 Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all

Goal 5 Achieve gender equality and empower all women and girls

Goal 6 Ensure availability and sustainable management of water and sanitation for all

Goal 7 Ensure access to affordable, reliable, sustainable and modern energy for all

Goal 8 Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all

Goal 9 Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation

Goal 10 Reduce inequality within and among countries

Goal 11 Make cities and human settlements inclusive, safe, resilient and sustainable

Goal 12 Ensure sustainable consumption and production patterns

Goal 13 Take urgent action to combat climate change and its impacts*

Goal 14 Conserve and sustainably use the oceans, seas and marine resources for sustainable

development

Goal 15 Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably

manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss

Goal 16 Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels

Goal 17 Strengthen the means of implementation and revitalize the global partnership for sustainable development

SDG Health-related Goal and Targets

3.2 Reducechild and

neonatal mortality

3.2 Reducechild and

neonatal mortality

3.3 Eterminar las epidemias de SIDA, tuberculosis, malaria

& enfermedades tropicalesdiseases y combatir hepatitis,

y otras transmisibles

3.3 Eterminar las epidemias de SIDA, tuberculosis, malaria

& enfermedades tropicalesdiseases y combatir hepatitis,

y otras transmisibles

3.1 ReduceMaternalmortality

3.1 ReduceMaternalmortality

3.5 Strengthen Prevention and

treatment of substance abuse (narcotics, alcohol)

3.5 Strengthen Prevention and

treatment of substance abuse (narcotics, alcohol)

3.6 Reduce mortality

due to road traffic injuries

3.6 Reduce mortality

due to road traffic injuries

3.4 Reducemortality due to NCD and

improve mental health

3.4 Reducemortality due to NCD and

improve mental health

3.8 Achieve universal

health coverage

3.8 Achieve universal

health coverage

3.9 Reducedeaths and illness due to pollution

and contamination

3.9 Reducedeaths and illness due to pollution

and contamination

3.7 Universalaccess to sexual and

reproductive health-care services

3.7 Universalaccess to sexual and

reproductive health-care services

3.a Strengthen implementation FCTC

(tobacco)

3.a Strengthen implementation FCTC

(tobacco)

3.b Access to affordable

essential medicines and

technologies

3.b Access to affordable

essential medicines and

technologies

3.c Increased health financing and health

workforce in developing countries

3.c Increased health financing and health

workforce in developing countries

3.d Enhance capacity for early warning, risk reduction and management of national

and global health risks

3.d Enhance capacity for early warning, risk reduction and management of national

and global health risks

Goal 3: Ensure healthy lives and promote well-being for all at all ages

(source; http://sustainabledevelopment.un.org/focussdgs.html)

Sustainable Development Goals 2016- 2030

Goal 1 End poverty in all its forms everywhere

Goal 2 End hunger, achieve food security and improved nutrition and promote sustainable agriculture

Goal 3 Ensure healthy lives and promote well-being for all at all ages

Goal 4 Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all

Goal 5 Achieve gender equality and empower all women and girls

Goal 6 Ensure availability and sustainable management of water and sanitation for all

Goal 7 Ensure access to affordable, reliable, sustainable and modern energy for all

Goal 8 Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all

Goal 9 Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation

Goal 10 Reduce inequality within and among countries

Goal 11 Make cities and human settlements inclusive, safe, resilient and sustainable

Goal 12 Ensure sustainable consumption and production patterns

Goal 13 Take urgent action to combat climate change and its impacts*

Goal 14 Conserve and sustainably use the oceans, seas and marine resources for sustainable development

Goal 15 Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably

manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss

Goal 16 Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels

Goal 17 Strengthen the means of implementation and revitalize the global partnership for sustainable development

Pasemos de controlar la TB a terminar la epidemia de TB en el 2030

•80% reduccion en casos

nuevos

•90% de reduccion en mortalidad

•100% de familias afectadas por TB sin gastos catastroficos

debidos a la enfermedad y su tratamiento

Vision:

Un mundo libre de TB Cero muertes,

Cero enfermedad, and

Cero sufrimiento

Meta:

Fin de la epidemia global de TB

Visión, meta, blancos, logros

blanco

Logro interino

Supuestos a cumplir para acertar en los blancos en el 2035

Optimizar uso de

las actuales

herramientas,

acceso universal a

salud, proteccion

social Introducir nuevas y mas efectivas herramientas

PILLAR 1: INTEGRADA, ATENCION CENTRADA EN EL PACIENTE, CON PREVENCION

PILAR 2: POLITICAS AMBICIOSAS CON SISTEMAS SOPORTIVOS

PILAR 3: INVESTIGACION E INNOVACION INTENSIFICADA

Huecos en el presupuesto

$1.4 billonesdeficit

$1.32 billonesdeficit

TAG TB R&D report 2014

INVESTIGACION–Al menos US$ 2 billones cada 12 meses

$677 disponibles en 2013

IMPLEMENTACION –Se necesitan US$8 billones en el 2015

En resumen… qué hay nuevo?

• Etica y promoción, protección de derechos humanos

• Reconocimiento del sufrimiento que vive el enfermo

• Atención centrada en el paciente

• Farmacovigilancia

• Tamizaje sistemático y terapia preventiva

• Cuidado paliativo

• Acceso universal a prueba de susceptibilidad a droga

• Tratamiento de infección latente

• Marco eliminación en paises de baja incidencia

• Agenda social que responda a necesidades del enfermo

• Herramientas digitales

• Urgente articulación con otros actores