References in the content below refer to the PBMEF Guide.
Definitions
Number of laboratory-confirmed drug-resistant tuberculosis (DR-TB) (which includes rifampicin resistant [RR]/multidrug-resistant [MDR] TB and extensively drug-resistant [XDR] TB) cases notified during the reporting year.
Numerator
Denominator
Ref # |
RN-1
|
Tier Level |
Core Indicator
|
Category |
Reach
|
Type |
Core Outcome
|
Unit of Measure |
Number of cases
|
Data Type |
Integer
|
Disaggregations |
Age
Gender
Subnational
|
Reporting Level |
National
|
Reporting Frequency |
Annually
|
This indicator is reported from national TB program (NTP) official records. Quarterly report on TB case registration in the basic management unit.
This standard WHO indicator can also be calculated using the WHO database variables: conf_rrmdr plus all_conf_xdr
Understanding the magnitude of DR-TB cases is key for any NTP to respond accordingly. These cases account for a much higher proportion of overall TB deaths, and the number of DR-TB cases has been increasing over time. DR-TB notification measures a country’s ability to detect drug resistance among the TB-infected population and enroll TB patients in appropriate treatment. Data on DR-TB notification are also valuable for planning drug logistics and supervision.
The global number of MDR/RR-TB cases notified in 2019 was 44% of the estimated 465,000 MDR/RR-TB incident cases in 2019. Closing this large detection gap will require improvements in diagnostic capacity. Point-of-care (or near point-of-care) rapid diagnostic tools that detect TB and drug resistance are the new standard of care. Early detection of resistance to rifampicin and isoniazid ensures that an appropriate drug regimen can be prescribed from the outset to increase the likelihood of treatment success, and to reduce the chance of acquiring additional resistance.
Understanding DR-TB notification trends is important to gauge the overall performance of the NTP in preventing the mergence of DR cases, either due to faulty adherence to treatment regimens or due to direct transmission of DR-TB. Drug-resistant TB notification can be analyzed on its own as a trend over time to see the total number of notified DR-TB cases within a given country. It can also be compared to the estimated incidence of DR-TB to determine the magnitude of the gap between estimated DR-TB cases and the DR-TB cases that have been detected. These gaps should also be reviewed in the context of availability of diagnostic services for DR-TB. The number of diagnostic facilities per 100,000 population can also give some indication of how accessible these services are to the population. The geographical distribution of the diagnostic facilities can help to understand the level of accessibility in different regions. Regional comparisons of this indicator could be helpful.
Additionally, it is useful to look at the proportion of DR-TB cases among the total number of notified TB cases to provide some insight into how the TB program is performing. DR-TB notification is an important step in the DR-TB treatment cascade. See Appendix 2 for additional steps in the cascade to monitor. Data can also be collected at the subnational level and used to learn from the geographic distribution of cases. Data should be reported annually at a minimum but semiannually or quarterly reporting will improve the timeliness of data for decision making.