Number of Provinces and HUCs in NTP



Region Province HUC Total
NCR 0 17 17
CAR 6 1 7
1 4 0 4
2 5 0 5
3 7 2 9
4 5 1 6
MIMAROPA 5 1 6
5 6 0 6
6 6 2 8
7 4 3 7
8 6 1 7
9 3 2 5
10 5 2 7
11 5 1 6
12 4 2 6
13 5 1 6
ARMM 5 0 5
Total 81 36 117

NTP DATA



  Based on the national prevalence surveys, WHO estimated the country’s TB burden as measured by the TB prevalence, incidence and mortality. For the last 15 years, the TB burden has been declining as shown by Figure 1 and 2 for TB incidence and TB mortality.

Fig. 1. Trend of TB incidence, 2000 - 20015


Fig.2 Trend of TB of TB incidence, 2000 - 2010


  Prevalence of TB has decreased from 775 cases per 100,000 in the 2000 to 417 cases per 100 000 in 2014. The decrease in TB prevalence estimates has accelerated in recent years, with a mean annual decrease of 4.5% in the past ten years, compared to mean annual decrease of 3.9% between 2000 and 2004. The WHO ceased to provide indirect estimate of TB prevalence after 2014 as it is no longer a high-level indicator.


  The estimated incidence was 322 per 100,000 or 320,000 new cases in total in 2015. The incidence has decreased at a stable 1.7% annually from 2000-2006. The estimated proportion of new cases with comorbid HIV infection has more than doubled since 2010, reaching 4.3 cases per 100,000 in 2015, 320,000 new cases in total.


  The estimated mortality rate has decreased from 27.4 per 100,000 people in 2010 to 13.5 in 2015, a 50 % reduction. However, the proportion of TB deaths with HIV co-infection has steadily increased to 0.44 cases per 100,000 in 2015. The case fatality rate has decreased from 10.9% in 2000 to 8.5% in 2010 to 4.2% in 2015.

TB Case Notification



  The case detection rate or currently known as TB treatment coverage has steadily increased since 2000 with 92% in 2015 (Figure 3) . The case notification rate for new cases (all forms) has shown parallel increase, reaching 276.8 cases per 100,000 persons in 2015. The increase is due to increased efforts in case finding through better access to TB microscopy laboratory as shown by the increasing presumptive TB examined, engagement of the private health care providers and hospitals and better community referral system. In 2016, 65 % of total notified TB cases came from the RHUs/HCs, 14% from the private health care providers, 14 % from other public health facilities like hospitals and 7 % were referred by the communities.

  However, since 2011, the number of smear negative (SN) TB has exceeded the number of smear positive (SP) TB and this gap has continued to increase in recent years. This gap resulted from (a) NTP’s target to detect all forms of TB since 2011, in accordance with the WHO recommendation, (b) over-diagnosis due to over-reliance on X-rays result, and (c) low sensitivity of the smear microscopy as a diagnostic tool. Low specificity of X-ray and histology could lead to increased false positive cases and patients unnecessarily starting TB treatment.

  Although the number of extra-pulmonary TB (EPTB) cases more than doubled since 2010, it is lower than the global case notification rate for extra-pulmonary TB. This could be due to the limited capability of primary care facilities to diagnose these cases or because such cases were diagnosed in health facilities outside of the NTP network. The program has seen an increase in reported EPTB cases from 2008 as more private and non-NTP public providers were recruited into the NTP network. Since 2013, the categorization of case notification changed. Smear positive (S+) and Xpert positive (Xp+) TB patients fall under the category of bacteriological confirmed (BC) patients. Smear negative (S-) and Xpert negative (Xp-)TB patients who get clinicians’s decision- to-treat now fall under the category of clinically diagnosed(CD) patients.

  The three most populous regions (NCR, IV-A and III) reported the highest number of cases – contributing 39% of all TB cases: 35% of BC TB, 42% of CD TB and 35% of EPTB. The composition of each TB type in each region across the country was approximately 54-70% CD TB, 25-43% BC TB and 1-4% EPTB. Accounting for population size, Region VI had the highest case notification rates across all regions for all forms of TB and for each type. On the other hand, ARMM had the lowest case notification rates and they were approximately half of the national values. Seven of the 17 regions had case notification rates at or above the national value for all forms of TB combined.

Figure 3: Trend of TB case detection rate and treatment success rate, 2000 – 2015

  In 2015, the case notification rate for new and relapse cases increased with age except for a dip in the age-group of 5-14 years. The case notification rate in individuals over 65 years old (789 cases per 100,000 persons) was more than 3-folds higher than that for individuals between 15 and 24 years (210 cases per 100,000 persons). Hence, case finding and prevention measures may be more cost-effective in the elderly age-groups because of higher prevalence rates of TB among them. However, the number of TB cases would be higher among the younger and middle-aged adults because they constitute a greater proportion of the general population.

  Case notification rate for new cases doubled between 2014 and 2015 for both males and females. The increase in case notification could be attributed to sex disaggregation in case reporting for NSP only (i.e. no EPTB or SN cases) prior to 2015.

  The male-to-female ratio remained at 1.9, which is consistent with the prevalence survey carried out in 2007. There were minimal variations in the sex ratio across regions (range 1.7-2.2) except for ARMM, where it was relatively lower among males.

Fig. 4. Case detection rate by region, 2015


NTP Tables and Data



Number of Presumptive TB Examined Add DSSM and Xpert
 DSSM Report 1a
Treatment Coverage, All Forms
Total number of All Forms of TB (DSTB and DRTB) notified and treated Add Report 3a and 3b relapse
Total number of TB Cases notified and treated Add DSTB and DRTB
 DSTB Report 3a
 DRTB Report 3b
Total number of Bacteriologically-confirmed RR/MDR/XDRTB Report 3b
Interim Outcome, BC RR/MDR/XDR (N & %) Report 5b
Treatment Success Rate, All Forms DSTB (N & %) Report 5a
Treatment Success Rate, BC RR/MDR/XDRTB (N & %) Report 5c

Number of DOTS Facilities
Number of TML
Number of Xpert Site
Number of PMDT S/TC

Add New and Relapse from Report 3a and 3b 0-4 5-14 15-24 25-34 35-44 45-54 55-64 >=65 Total
Male
Female
Total

Number of Presumptive TB Examined (DSSM) Number of Presumptive TB Examined (Xpert) Treatment Coverage, All Forms Total number of All Forms of TB (DSTB and DRTB) notified and treated Total number of TB Cases notified and treated (DSTB Total number of TB Cases notified and treated (DRTB) Total number of Bacteriologically-confirmed RR/MDR/XDRTB Interim Outcome, BC RR/MDR/XDR (N & %) Treatment Success Rate, All Forms DSTB (N & %) Treatment Success Rate, BC RR/MDR/XDRTB (N &
NCR
CAR
1
2
3
4
MIMAROPA

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