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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
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