The Sustainable Development Goals (SDGs) for 2030 were adopted by the United Nations in 2015. One of the targets is to end the global TB epidemic. The WHO End TB Strategy, approved by the World Health Assembly in 2014, calls for a 90% reduction in TB deaths and an 80% reduction in the TB incidence rate by 2030, compared with 2015.
This global TB report is the first to be produced in the era of the SDGs and the End TB Strategy. It provides an assessment of the TB epidemic and progress in TB diagnosis, treatment and prevention eforts, as well as an overview of TB-specific financing and research. It also discusses the broader agenda of universal health coverage, social protection and other SDGs that have an impact on health. Data were available for 202 countries and territories that account for over 99% of the world’s population and TB cases.
Main findings and messages
Status of the TB epidemic and MDR-TB crisis
The TB epidemic is larger than previously estimated, reflecting new surveillance and survey data from India. However, the number of TB deaths and the TB incidence rate continue to fall globally and in India.
In 2015, there were an estimated 10.4 million new (incident) TB cases worldwide, of which 5.9 million (56%) were among men, 3.5 million (34%) among women and 1.0 million (10%) among children. People living with HIV accounted for 1.2 million (11%) of all new TB cases.
Six countries accounted for 60% of the new cases: India, Indonesia, China, Nigeria, Pakistan and South Africa.1 Global progress depends on major advances in TB prevention and care in these countries. Worldwide, the rate of decline in TB incidence remained at only 1.5% from 2014 to 2015.
This needs to accelerate to a 4–5% annual decline by 2020 to reach the first milestones of the End TB Strategy.
In 2015, there were an estimated 480 000 new cases of multidrug-resistant TB (MDR-TB) and an additional 100 000 people with rifampicin-resistant TB (RR-TB) who were also newly eligible for MDR-TB treatment.2 India, China and the Russian Federation accounted for 45% of the combined total of 580 000 cases.
There were an estimated 1.4 million TB deaths in 2015, and an additional 0.4 million deaths resulting from TB disease among people living with HIV.3 Although the number of TB deaths fell by 22% between 2000 and 2015, TB remained one of the top 10 causes of death worldwide in 2015.
TB care and prevention results
TB treatment averted 49 million deaths globally between 2000 and 2015, but important diagnostic and treatment gaps persist.
In 2015, 6.1million new TB cases were notified to national authorities and reported to WHO. Notified TB cases increased from 2013–2015, mostly due to a 34% increase in notifications in India. However, globally there was a 4.3 million gap4 between incident and notified cases, with India, Indonesia and Nigeria accounting for almost half of this gap.5 The crisis of MDR-TB detection and treatment continues.
In 2015, of the estimated 580 000 people newly eligible for MDR-TB treatment, only 125 000 (20%) were enrolled. Five countries accounted for more than 60% of the gap: India, China, the Russian Federation, Indonesia and Nigeria.5 Globally, the MDR-TB treatment success rate was 52% in 2013.6 In 2015, 55% of notified TB patients had a documented HIV test result. The proportion of HIV-positive TB patients on antiretroviral therapy (ART) was 78%.
Access to TB preventive treatment needs to be expanded. A total of 910 000 people living with HIV were started on such treatment in 2015, as well as 87 000 children under five (7% of those eligible).
***TB financing, universal health coverage, social protection and social determinants**
US$ 6.6 billion was available for TB care and prevention in low and middle-income countries in 2016, of which 84% was from domestic sources. Nonetheless, national TB programmes (NTPs) in low-income countries continue to rely on international donors for almost 90% of their financing. Investments in low and middle-income countries fall almost US$ 2 billion short of the US$ 8.3 billion needed in 2016. This annual gap will widen to US$ 6 billion in 2020 if current funding levels do not increase.
Improvements are also needed in overall health financing. Government expenditures on health in 2014 were less than the WHO benchmark of at least 6% of gross domestic product (GDP) in 150 countries. Out-of-pocket expenditures exceeded 45% of total health expenditures in 46 countries, including 11 of the 30 high TB burden countries.
TB research and development
Despite some progress in the pipeline for new diagnostics, drugs and regimens, and vaccines, TB research and development remains severely underfunded.