2019全球结核病报告（英文版）.pdf

GLOBAL TUBERCULOSIS REPORT 2019Global tuberculosis report 2019 ISBN 978-92-4-156571-4 World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; creativecommons/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. Global tuberculosis report 2019. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Designed by minimum graphics Cover designed by Irwin Law Printed in France WHO/CDS/TB/2019.15GLOBAL TUBERCULOSIS REPORT 2019 iii Contents Foreword v Message from the WHO Global TB Programme vi Acknowledgements vii Abbreviations xi Executive Summary 1 Chapter 1 Introduction 7 Chapter 2 Global commitments to end TB and multisectoral accountability 9 Chapter 3 TB disease burden 27 Chapter 4 TB diagnosis and treatment 73 Chapter 5 TB prevention services 111 Chapter 6 Financing for TB prevention, diagnosis and treatment 123 Chapter 7 Universal health coverage, multisectoral action and social determinants 141 Chapter 8 TB research and development 165 Annexes 1. The WHO global TB database 183 2. Country profiles for 30 high TB burden countries 189 3. Regional and global profiles 251 4. TB burden estimates, notifications and treatment outcomes 261GLOBAL TUBERCULOSIS REPORT 2019 v Foreword It has been a year since the historic United Nations (UN) high-level meeting on tuberculosis (TB) that brought together world leaders to accelerate the TB response. The commitments made at the meeting are currently being translated into action in countries, supported by the “Find. Treat. All. #EndTB” initiative of the World Health Organization (WHO), the Stop TB Partnership and the Global Fund to Fight AIDS, Tuberculosis and Malaria. This years global TB report reveals that countries are making progress. About 7 million people were reported to have been reached with quality TB care in 2018, up from 6.4 million in 2017. In addition, TB-related deaths dropped from 1.6 million in 2017 to 1.5 million in 2018. However, TB remains the top infectious killer worldwide, with 10 million people falling ill with TB in 2018. Although some countries are significantly accelerating their TB response, most WHO regions and many high-burden countries are still not on track to reach the 2020 milestones of the End TB Strategy. About 3 million people with TB did not access quality care in 2018. The situation is even more acute for people with drug-resistant TB, with only one in three accessing treatment. Prevention efforts are expanding but need to be intensified. Funding gaps of close to US$ 5 billion annually impede progress in the overall TB response, including TB research. To ensure that we match our talk with real, lasting change, WHO released a multisectoral accountability framework at this years World Health Assembly, to help countries drive action with accountability across all sectors. Sustained progress will require a commitment to universal health coverage, based on strong primary health care, as underscored at the high-level meeting on universal health coverage at the UN General Assembly this year. Ultimately, the best investment that countries can make to ensure faster progress towards ending TB is to ensure that TB services are designed and delivered as part of an overall commitment to universal health coverage, built on the foundation of strong primary health care. WHO is committed to working with countries to ensure TB services are integrated into national benefit packages to ensure that no one misses out on the services they need, or is impoverished by using them. The WHO global TB report delivers a clear message: sustained acceleration of efforts and increased collaboration are urgently required to turn the tide of the TB epidemic. To maintain momentum, I personally wrote to Heads of State this year urging them to keep the promises made at last years high-level meeting on TB. This was followed by a joint statement with the WHO civil society taskforce. Civil society, partners and affected communities are important drivers of progress against this top killer. Our vision is that no one with TB will miss out on the care they need. WHO will stand by every country, partner, society or person that decides TB has no place in its future. It is time to deliver. There has never been a better opportunity to make TB history. Dr Tedros Adhanom Ghebreyesus Director-General World Health OrganizationGLOBAL TUBERCULOSIS REPORT 2019 vi Message from the WHO Global TB Programme This is a pivotal moment for the global fight to end tuberculosis (TB). For the first time, we have political commitment at the highest level from heads of state, ministers and other leaders. Member States, partners and civil society are all united in working towards accelerating the response to end TB the worlds top infectious disease killer. This years global TB report showcases global, regional and country progress, while highlighting that much remains to be done to reach the TB targets set in the World Health Organization (WHO) End TB Strategy, the United Nations (UN) Sustainable Development Goals (SDGs) and the political declaration at last years UN high-level meeting on TB. It is now imperative to maintain the positive momentum we have achieved. In this report, WHO is announcing that the first milestone towards one of the targets set in the political declaration at the UN high-level meeting on TB has been achieved: 7 million people were reached with TB care in 2018. Nonetheless, there were still around 3 million people with TB who either had no access to quality care or were not reported, and only one in three people with drug-resistant TB accessed care. There has been an expansion of access to TB preventive treatment, but the numbers currently being reached fall far short of what is needed to reach the target of providing preventive treatment to at least 30 million people in the period 20182022. The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) has recently been replenished with more resources than ever before for HIV, TB and malaria, but despite this good news, progress continues to be impeded by shortfalls in domestic and international funding for TB prevention and care, and for TB research. WHO has been intensifying its efforts to support countries in accelerating the TB response, with the engagement of all stakeholders. Actions taken in the past year include high-level missions to countries to optimize the national response; the development and roll-out of new guidelines, roadmaps and tools; the implementation of the WHO Director-Generals Flagship initiative, “Find. Treat. All. #EndTB”, undertaken jointly with the Global Fund and the Stop TB Partnership; strengthened collaboration with civil society; and implementation of a multisectoral accountability framework for TB to drive sustained action across all sectors. As we look forward, 2020 is a critical year when Member States will report to the WHO Director-General and UN Secretary-General on progress towards the targets of the SDGs, the End TB Strategy and the UN high-level meeting. As a precursor to the next critical year, this years global TB report highlights that although we have achieved much in the fight to end TB, we can and must do better. It is time to critically analyse, review and optimize programmes; strengthen surveillance systems; and move decisively from rhetoric to action. We believe that the WHO global TB report is essential for this effort, and for high- level advocacy, increasing awareness and fundraising. Knowledge and data are powerful weapons in the fight against TB. That is why the WHO global TB report is for you. Read it, know more about TB and act! Dr Tereza Kasaeva Director, Global Tuberculosis Programme World Health OrganizationGLOBAL TUBERCULOSIS REPORT 2019 vii Acknowledgements This global TB report was produced by a core team of 18 people: Annabel Baddeley, Anna Dean, Hannah Mon- ica Dias, Dennis Falzon, Carmen Figueroa, Katherine Floyd, Ins Garcia Baena, Nebiat Gebreselassie, Philippe Glaziou, Marek Lalli, Irwin Law, Cecily Miller, Nobuyuki Nishikiori, Gita Parwati, Charalambos Sismanidis, Lana Syed, Hazim Timimi and Yinyin Xia. The team was led by Katherine Floyd. Overall guidance was provided by the Director of the Global TB Programme, Tereza Kasaeva. The data collection forms (long and short versions) were developed by Philippe Glaziou and Hazim Timimi, with input from staff throughout the WHO Global TB Pro- gramme. Hazim Timimi led and organized all aspects of data management. The review and follow-up of data was done by a team of reviewers that included Annabel Baddeley, Anna Dean, Carmen Figueroa, Ins Garca Baena, Giuliano Gargioni, Medea Gegia, Shagun Khare, Alexei Korobitsyn, Tiziana Masini, Tom Matas, Andrea Pantoja, Gita Parwati, Kefas Samson, Lana Syed, Hazim Timimi, Olga Tosas Auguet, Eloise Valli and Yinyin Xia. Data for the European Region were collected and val- idated jointly by the World Health Organization (WHO) Regional Office for Europe and the European Centre for Disease Prevention and Control (ECDC); we thank in par- ticular Csaba Kdmn and Hanna Merk from ECDC for providing validated data files and Andrei Dadu and Giorgi Kuchukhidze from the WHO Regional Office for Europe for their follow-up and validation of data for all Europe- an countries. UNAIDS managed the process of data col- lection from national AIDS programmes and provided access to their TB/HIV dataset. Review and validation of TB/HIV data was undertaken in collaboration with UNAIDS staff. The report team is also grateful to reviews of data for specific countries that were done by Sevim Ahmedov, Amna Al-Gallas-Streeter, Kenneth Castro, Thomas Chiang, Alexander Golubkov and Edmund Rutta. Many people contributed to the analyses, preparation of figures and tables, and writing required for the main chapters of the report. Unless otherwise specified, those named work in the WHO Global TB Programme. Chapter 1 (Introduction) was written by Katherine Floyd. She also prepared Chapter 2 (Global commitments to end TB and multisectoral accountability) and the Exec- utive Summary, with inputs from Hannah Monica Dias, Jamie Guth (WHO consultant), Tereza Kasaeva and Diana Weil. Chapter 3 (TB disease burden) was prepared by Anna Dean, Peter Dodd (University of Sheffield), Katherine Floyd, Philippe Glaziou, Irwin Law and Olga Tosas Auget (WHO consultant). The chapter authors are grateful to Andrea Cabibbe (San Raffaele Scientific Institute) for his contributions to the two boxes on drug resistance sur- veillance, and to Ikushi Onozaki (WHO Country Office, Myanmar) and staff from the national TB programmes of Myanmar and Viet Nam for their contributions to the boxes featuring results from the recent national TB prev- alence surveys in these countries. Chapter 4 (Diagnosis and treatment of TB, HIV- associated TB and drug-resistant TB) was prepared by Charalambos Sismanidis, Hazim Timimi and Yinyin Xia, with contributions from Annabel Baddeley, Hannah Monica Dias, Dennis Falzon, Katherine Floyd, Philippe Glaziou, Lic Gonzalez Angulo, Irwin Law, Fuad Mirzayev and Lana Syed. Chapter 5 (TB prevention services) was prepared by Annabel Baddeley, Dennis Falzon, Carmen Figueroa, Avinash Kanchar and Yinyin Xia, with contributions from Katherine Floyd and Hazim Timimi. Chapter 6 (Financing for TB prevention, diagnosis and treatment) was prepared by Ins Garcia Baena and Peter Nguhiu (WHO consultant), with support from Katherine Floyd and Marek Lalli. Estimates of resource needs that will be included in the Stop TB Partnerships upcoming Global Plan to End TB 20182022 were kindly provided by Carel Pretorius (Avenir Health). Chapter 7 (Universal health coverage, multisectoral action and social determinants) was prepared by Nobuyu- ki Nishikiori with support from Katherine Floyd and Ins Garcia Baena. The box on the direct benefit transfer scheme in India was written by Amy Colli