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OUT OF STEP 2017

• All countries have policies in place to carry out active case finding for children under 5 years old who have been living in the same household as a confirmed TB patient. Half of these countries have widely implemented this policy; • In 86% (25) of countries, there are policies in place to carry out active casefinding for all household contacts regardless of age, although only 44% (11/25) of these countries have widely implemented this policy; • All countries have policies in place to conduct active casefinding among people living with HIV, and 66% (19) have widely implemented it. CAR is the only country for which the active casefinding policy for people living with HIV is unknown.

Alexis Huguet/MSF

PREVENTION

FINDINGS:

FUNDZILE MSIBI, MSF PSYCHOSOCIAL COORDINATOR, ENGAGES CHILDREN DURING AN HIV AND TB EDUCATION ROAD SHOW IN BUNYA, SWAZILAND.

Preventive treatment in children and people living with HIV/AIDS WHO recommends prioritising those most vulnerable to developing severe and disseminated forms of TB, including children under 5 years old and people living with HIV/AIDS.

PEOPLE LIVING WITH HIV The risk for TB reactivation is much higher for people living with HIV, who face an annual reactivation risk of 5% to 15%,132 and TB is likely to be deadlier. Since 1998, WHO has recommended preventive therapy for all people living with HIV (without signs and symptoms of active TB).133 Preventive therapy protects HIV-positive people from TB, even at high CD4 cell counts (>500 cells/μL), and especially when used in combination with ART.55 However, countries have been slow to roll out preventive therapy (see table 12, Preventive therapy in countries surveyed (2015)). Worldwide, an estimated 37 million people were living with HIV/AIDS in 2015,134 and 2.4 million of them were newly enrolled in care in 2015.1 Only 910,000 (38%) started on preventive therapy.1

CHILD HOUSEHOLD CONTACTS Globally, an estimated 1 million children under 15 years old developed TB in 2015;135 it is estimated that half of them were under 5. TB is especially serious for children in this age group. Children are more vulnerable; TB is harder to diagnose in them and they are more likely to have serious forms of the disease, such as TB meningitis or disseminated TB; and the disease usually progress rapidly.136

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Médecins Sans Frontières and Stop TB Partnership – July 2017

In 2015, 1.2 million children under 5 years old were estimated to be household contacts of infectious TB patients and therefore eligible for preventive therapy; yet only 7.1% (or 87, 000) of them received it (see table 12, Preventive therapy in countries surveyed).1

PREVENTING MDR-TB Treating household contacts of MDR-TB patients could help to prevent the spread of MDR-TB. By the time a person with MDR-TB is diagnosed, 5% to 10% of their household contacts have active TB and nearly 50% of them have LTBI.130 Preventive therapy for latent MDR-TB is challenging and relies on medicines that are likely to be effective, as DST can only be performed in people with active TB, and their contacts do not always have the same form of TB. Nonetheless, given the toxicity, limited effectiveness and expense of DR-TB treatment, it is critical to prevent progression of drug-resistant LTBI. Treatment of people who have been exposed to drug-resistant forms of TB is complicated, and relies on a detailed exposure history. All persons exposed to DR-TB should have urgent clinical assessments to look for active disease, so they can promptly be started on therapy based on the drug susceptibility pattern of the known source case. In persons without active TB disease, two strategies may be followed: The first involves ongoing screening and monitoring for signs and symptoms of active

결핵: 새 보고서 – 세계에서 가장 치명적인 감염병 결핵을 각국이 아직도 해결하지 않고 있다는 사실 드러내  

국경없는의사회와 세계보건기구(WHO) 산하 ‘결핵 퇴치 국제협력사업단’(Stop TB Partnership)은 ‘Out of Step’ 보고서 3판을 발표했다. 이 보고서는 세계에서 가장 치명적인 감염병인 결핵에 맞서기 위해 각국 정부가 더 큰 노력을...

결핵: 새 보고서 – 세계에서 가장 치명적인 감염병 결핵을 각국이 아직도 해결하지 않고 있다는 사실 드러내  

국경없는의사회와 세계보건기구(WHO) 산하 ‘결핵 퇴치 국제협력사업단’(Stop TB Partnership)은 ‘Out of Step’ 보고서 3판을 발표했다. 이 보고서는 세계에서 가장 치명적인 감염병인 결핵에 맞서기 위해 각국 정부가 더 큰 노력을...