Multidrug-/

rifampicin-
resistant TB
(MDR/RR-TB):
Update 2018
 The global TB situation (1)
Estimated Estimated number
incidence, 2017 of deaths, 2017

10.0 million 1.3 million*

All forms of TB
(9.0–11.1 million) (1.2–1.4 million)

0.9 million 300,000

HIV-associated TB (266,000–335,000)
(0.8–1.0 million)

Multidrug- /
558,000 230,000
rifampicin-resistant (483,000–639,000) (140,000–340,000)
TB (MDR/RR-TB)

Source: WHO Global Tuberculosis Report 2018 * Excluding deaths attributed to HIV/TB
 The global TB situation (2)
Estimated TB incidence and mortality, 2000-2017
 The Global Project on Anti-TB Drug
Resistance Surveillance, 1994-2018
Global
Project
launched
SRL network
launched 1st global 2nd global 3rd global 4th global M/XDR-TB Global
DRS report DRS report DRS report DRS report report TB reports

1994 1997 2000 2003 2004 2008 2009 2010 2018

1st ed. DRS 2nd ed. DRS 3rd ed. DRS 4th ed. DRS 5th ed. DRS
guidelines guidelines guidelines guidelines guidelines
 WHO TB Supranational Reference
Laboratory Network (SRLN)

Source: http://www.who.int/tb/areas-of-work/laboratory/srl-network/en/ (21 Sep 2018)

Measuring TB drug resistance
Periodic surveys vs. continuous surveillance
Measuring TB drug resistance
Year of most recent data since 1995
 Percentage of new and previously treated
TB cases with MDR/RR-TB, 2017

a
Best estimates are for the latest available year
 % MDR/RR-TB in new TB cases

Figures are based on the most recent year for which data have been reported, which varies among countries. Data cover the period 2002–2018
% MDR/RR-TB in previously treated TB cases

Figures are based on the most recent year for which data have been reported, which varies among countries. Data cover the period 2005–2018. The
high percentages of previously treated TB cases with RR-TB in Belize, Guam and Sao Tomé and Principe refer to only a small number of notified cases
(range: 1–8 notified previously treated TB cases).
30 high MDR-TB burden countries
 Estimated incidence of MDR/RR-TB, 2017
for countries with at least 1000 incident cases

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization 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 lines on maps represent approximate border lines
for which there may not yet be full agreement.
 WHO 2018. All rights reserved
Trends in new TB (blue) and new MDR-TB (red) case rates
selected high MDR-TB burden countries
 Isoniazid-resistant TB cases (Hr-TB)
Expected burden of Hr-TB among all new and all retreatment TB cases
notified globally in 2017 (compared with MDR/RR-TB)
 Pyrazinamide resistance

Source: Zignol M et al. Lancet Infect Dis. 2016 Jul 7. pii: S1473-3099(16)30190-6
 Countries ever notifying an XDR−TB case

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization 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 lines on maps represent approximate border lines
for which there may not yet be full agreement.
 WHO 2018 All rights reserved
 Moxifloxacin resistance

Source: Zignol M et al. Lancet Infect Dis. 2016 Jul 7. pii: S1473-3099(16)30190-6
DR-TB RESPONSE
 Diagnostic DST (1)
% of all TB cases tested for RR-TB, 2009− 2017
 Diagnostic DST (2)
% of MDR/RR-TB cases with DST results for
fluoroquinolones and 2nd line injectable agents

2016 data were used for 18 countries

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization 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 lines on maps represent approximate border lines
for which there may not yet be full agreement.
 WHO 2018. All rights reserved
 MDR/RR-TB detection and treatment
MDR/RR-TB cases detected (green) and number enrolled on MDR-TB treatment (violet) 2009-
2017, compared with incident MDR/RR-TB cases in 2017 (uncertainty interval shown in blue)
MDR/RR-TB treatment coverage

Enrolments on MDR-TB treatment as

a % of the incident MDR/RR-TB cases,
30 high MDR−TB burden countries,
regions and globally, 2017
Countries that had used bedaquiline for M/XDR-TB by 2017
as part of expanded access, compassionate use or under programmatic conditions

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization 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 lines on maps represent approximate border lines
for which there may not yet be full agreement.
 WHO 2018. All rights reserved
 Number of patients with laboratory-confirmed
XDR-TB started on treatment in 2017
white=no information

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization 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 lines on maps represent approximate border lines
for which there may not yet be full agreement.
 WHO 2018. All rights reserved
Outcomes of MDR/RR-TB treatment
Annual cohorts, by WHO region and global, 2007-2015
 Outcomes of XDR-TB treatment
2015 cohort*, by WHO region and global

*number of cases observed shown next to the bars

In 2017, were text, VOT, MEMS or other digital
technologies being used to support patients at
risk of interrupting TB treatment?
MDR/RR-TB and financing (1)
Funding for prevention, diagnosis and treatment
by intervention area, 2006—2018
(constant 2018 US$ billions)
MDR/RR-TB and financing (2)
Estimated funding needed for TB control in
low- and middle-income countries, 2016—2020
 MDR/RR-TB and financing (3)
Funding for drug-susceptible TB (green) and MDR-TB (red), 2006–2018,
by country group (constant 2018 US$ millions)
In summary 5 priority actions