La estrategia «Fin de la Tuberculosis» Ernesto Jaramillo 23 Noviembre, 2015 Barcelona

La estrategia «Fin de la Tuberculosis» Ernesto Jaramillo 23 Noviembre, 2015 Barcelona

Reducción de 47% en mortalidad por TB desde 1990 Rate per 100,000 population Blanco 1990 2000 2015

43 millones de muertes por TB evitadas entre el 2000 y el 2014 TB = 43m VIH = 7.8m Malaria = 7m Ref: Global TB Control Report 2015

1.5 millones de muertes por TB en el 2014 estimadas y/o reportadas 890,000 hombres / 480,000 mujeres /140,00 niños

TB es junto a VIH una causa principal de muerte 2012, Observatorio de Salud Global OMS 2014, OMS y ONUSIDA TB TB HIV/AIDS En gris: muertes TB/HIV HIV/AIDS Millones

9.6 millones caen enfermos con TB en el 2014 Casos de TB estimados y/o reportados 5 4 m hombres / 3 2 m mujeres /1m niños

~3.6 millones estimados no son diagnosticados ni reportados 9.6 millones estimados 6 millones notificados 10 estados tienen 75% (2.7 millones) de los casos extraviados Ref: Global TB Control Report 2015

Incidencia de TB: países y regiones

TB/VIH Prevalencia estimada de VIH en casos nuevos de TB en 2014 74% de casos TB/HIV reportados en Africa Ref: Global TB Control Report 2015

TB-MDR: 3% de los casos nuevos de TB Porcentaje de casos nuevos de TB con TB-MDR Ref: Global TB Control Report 2015 Mayor parte en antigua URSS India, China, Russia, Pakistan y Ucrania tienen 62% de todos los casos

Crisis de TB-MDR persiste 480 000 cases of MDR-TB estimated in 2014 123 000 111 000 50% 50% Tres de los 27 paises con alta carga reportaron exito de Tratamiento en 75%

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 TB Estrategia Fin de la TB Lo esencial! Lo esencial en el contexto del sistema de salud Integrar prevencion con tratamiento

Context global METAS DE DESARROLLO SOSTENIBLE - META 3.3 INCLUYE FIN DE LA EPIDEMIA DE TB EN EL 2030

Metas de desarrollo del milenio en TB Incidencia Prevalencia Mortalidad Rate per 100,000 population blanco blanco 41% declive desde 1990 45% declive desde 1990 MDM lograda No se alcanzó Meta al alcance Source: WHO Global TB Report 2014

Sustainable Development Goals 2016-2030 Goal 1 Goal 2 Goal 3 Goal 4 Goal 5 Goal 6 Goal 7 Goal 8 Goal 9 Goal 10 Goal 11 Goal 12 Goal 13 Goal 14 Goal 15 Goal 16 Goal 17 End poverty in all its forms everywhere End hunger, achieve food security and improved nutrition and promote sustainable agriculture Ensure healthy lives and promote well-being for all at all ages Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all Achieve gender equality and empower all women and girls Ensure availability and sustainable management of water and sanitation for all Ensure access to affordable, reliable, sustainable and modern energy for all Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation Reduce inequality within and among countries Make cities and human settlements inclusive, safe, resilient and sustainable Ensure sustainable consumption and production patterns Take urgent action to combat climate change and its impacts* Conserve and sustainably use the oceans, seas and marine resources for sustainable development Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels Strengthen the means of implementation and revitalize the global partnership for sustainable development (source: http://sustainabledevelopment.un.org/focussdgs.html)

SDG Health-related Goal and Targets Goal 3: Ensure healthy lives and promote well-being for all at all ages 3.1 Reduce Maternal mortality 3.2 Reduce child and neonatal mortality 3.3 Eterminar las epidemias de SIDA, tuberculosis, malaria & enfermedades tropicales diseases y combatir hepatitis, y otras transmisibles 3.4 Reduce mortality due to NCD and improve mental health 3.5 Strengthen Prevention and treatment of substance abuse (narcotics, alcohol) 3.6 Reduce mortality due to road traffic injuries 3.7 Universal access to sexual and reproductive health-care services 3.8 Achieve universal health coverage 3.9 Reduce deaths and illness due to pollution and contamination 3.a Strengthen implementation FCTC (tobacco) 3.b Access to affordable essential medicines and technologies 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

Sustainable Development Goals 2016-2030 Goal 1 Goal 2 Goal 3 Goal 4 Goal 5 Goal 6 Goal 7 Goal 8 Goal 9 Goal 10 Goal 11 Goal 12 Goal 13 Goal 14 Goal 15 Goal 16 Goal 17 End poverty in all its forms everywhere End hunger, achieve food security and improved nutrition and promote sustainable agriculture Ensure healthy lives and promote well-being for all at all ages Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all Achieve gender equality and empower all women and girls Ensure availability and sustainable management of water and sanitation for all Ensure access to affordable, reliable, sustainable and modern energy for all Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation Reduce inequality within and among countries Make cities and human settlements inclusive, safe, resilient and sustainable Ensure sustainable consumption and production patterns Take urgent action to combat climate change and its impacts* Conserve and sustainably use the oceans, seas and marine resources for sustainable development Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels Strengthen the means of implementation and revitalize the global partnership for sustainable development (source; http://sustainabledevelopment.un.org/focussdgs.html)

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

Visión, meta, blancos, logros Vision: Un mundo libre de TB Cero muertes, Cero enfermedad, and Cero sufrimiento Meta: Fin de la epidemia global de TB Logro interino blanco

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 IMPLEMENTACION Se necesitan US$8 billones en el 2015 $1.4 billones deficit INVESTIGACION Al menos US$ 2 billones cada 12 meses $1.32 billones deficit $677 disponibles en 2013 TAG TB R&D report 2014

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