Ana Bierrenbach WHO /STB / TME bierrenbacha@whot

1. Measuring TB incidence, prevalence and mortality: an overview of the recommendations of the WHO Global Task Force on TB Impact Measurement Ana Bierrenbach WHO /STB / TME bierrenbacha@who.int http://www.who.int/tb/advisory_bodies/impact_measurement_taskforce/en/index.html

2. Mandate • To produce a robust, rigorous and widely-endorsed assessment of whether the 2015 targets for reductions in TB incidence, prevalence and mortality are achieved at global level, for each WHO Region and in individual countries • To regularly report on progress towards these targets in the years leading up to 2015 • To strengthen national capacity in monitoring and evaluation of TB control

3. 3 strategic areas of work • Use ofroutine surveillance datato measure incidence, prevalence and mortality (all countries) • Prevalence of TB disease surveysin at least 21 global focus countries • Periodic review and revision of methods used to translate data from surveillance systems and surveys into estimates of disease burden

4. Time-changes in notifications Changes in case-finding Changes in TB determinants Trends in notifications reflect trends in incidence Framework for systematic assessment of surveillance data Reports completed No dups, no misclassifications Consistency of data Accuracy/completeness VR DataQuality IMPROVE surveillance system Changes over time Trends Inventory studies capture re-capture"onion" model VR data UPDATED estimates Incidence and Mortality notifications ≈ incidence VR mortality data ≈ deaths CERTIFIED

5. Progress in applying framework in 2009 4 regional workshops (red) with > 50 countries, 3 country missions (blue) NB highlighted the necessity of electronic recording and reporting

6. An example from Tanzania: updated estimates of TB incidence from 1995 to 2007

7. Recommendations for strengthening surveillance and related estimates of disease burden • Need to revise TB/HIV dedicated form → more data on HIV status by case type available, easier to separate effect of incidence and case-finding efforts on notifications • Reconstruct historical data at district level – much data available that cannot yet be used • Record treatment outcome by HIV status • Strengthen capacity to analyse surveillance data, initially at national level • Make greater use of surveillance data to help identify where and how programme performance can be improved→ policy change • Feed back results of data analysis to lower administrative levels • Strengthen supervision at all levels: M&E, lab, …

8. The 21 global focus countries for TB disease prevalence surveys Asian countries on track, African countries not

9. Criteria used to identify 21 global focus countries

10. Updated methods • Three Task Force meetings • Major outcomes • Systematic documentation of uncertainty • Reassessment of trends based on systematic analysis of surveillance and programmatic data • Systematic documentation of expert opinion and how this has been used • Simplification of models • Better use of mortality data

11. Where to find more information about the Task Force recommendations • Lancet review article published on methods for measuring TB incidence, prevalence and mortality (Jan '08) • Policy paper building on Lancet review (Sep 08, finalized '09) • Web site (Sep '09) http://www.who.int/tb/advisory_bodies/impact_measurement_taskforce/en/index.html