References in the content below refer to the PBMEF Guide.
Definitions
Percent of people with new and relapse TB and with unknown previous TB treatment history (all forms) who were notified during the reporting period, out of the estimated number of people with incident TB for that year.
Note: This indicator is also referred to as “Treatment Coverage Rate”; the name is updated to TB detection rate here to emphasize that treatment coverage is not represented in this data.
Calculation: (Numerator/Denominator) x 100
Numerator
Denominator
Ref # |
DT_RT
(Previously DT-3) |
Tier Level |
Core Indicator
|
Category |
Reach
|
Type |
Core Outcome
|
Unit of Measure |
Percent of estimated TB
|
Data Type |
Percentage
|
Disaggregations |
Age (<15, 15+)
Sex
|
Reporting Level |
All Core PBMEF indicators should be reported at the national level; data may also be collected subnationally for more granular monitoring.
|
Reporting Frequency |
This indicator should be reported on a semiannual basis at a minimum. More frequent monitoring on a quarterly or monthly basis is recommended. Performance plans and reports (PPRs) for this indicator are based on calendar year (CY) periodicity to reflect national level attainment and align with the USAID congressional reporting requirements.
|
The numerator is reported from National TB Program (NTP) official records. Quarterly report on TB case registration in the basic management unit.
This indicator is related to incident TB; therefore, the following category of patients should not be included in the data reported:
- Treatment after failure patients (previously been treated for TB and whose treatment failed at the end of their most recent course of treatment)
- Treatment after loss to follow-up patients (previously been treated for TB and were declared lost to follow-up at the end of their most recent course of treatment)
- Other previously treated patients
Care should be taken to properly address common issues in reporting such as patients transferring in and out of facilities. National reporting guidelines should be followed to ensure all people with TB are reported and not double counted.
The denominator is available from the current World Health Organization (WHO) Global TB Report for the 30 TB high-burden countries and on the WHO country profile for all countries published on the WHO website. It is an estimation calculated annually based on a mathematical model.
This is a standard WHO indicator. Referring to the WHO database, the variable for the numerator is c_newinc and the variable for the denominator is e_inc_num.
Case finding is a fundamental principle of effective TB programming. However, one-third of the people who are estimated to fall ill with TB each year are not reached with proper screening, detection, and treatment, or are under-reported. The inability to find and treat the “missing” cases hampers efforts to make further progress in TB care. This indicator measures country-level progress in finding and diagnosing people with TB. Globally, the TB detection rate was 61% in 2021, down from 71% in 2019. The COVID-19 pandemic continues to reverse gains made in access to TB diagnosis and treatment, and progress achieved in the years up to 2019 has slowed, stalled, or reversed and global TB targets are off track. The most obvious and immediate impact was a large global drop in the reported number of people newly diagnosed with TB, from a peak of 7.1 million in 2019; this fell to 5.8 million in 2020 (–18%), back to the level last seen in 2012. In 2021, there was a partial recovery, to 6.4 million (the level of 2016–2017). Overall, there is a large gap between the estimated number of people with incident TB and the number of people with new TB diagnoses reported due to a combination of under-reporting of detected TB and under diagnosis.
Country national strategic plans (NSPs) for TB set annual targets for the number of TB notifications. This target will vary by country, but each country should be trying to achieve the End TB Strategy and United Nations High-Level Meeting (UNHLM) target of 90% or more case detection by 2025 to close the gap between estimated incidence and actual notifications. The USAID TB strategy (2023-2030) also sets the same target that 90% of people with incident TB are diagnosed and initiated on treatment, and specifies that at least 75% of people with TB should be tested with molecular WHO-recommended rapid diagnostic tests (mWRDs) in each USAID priority country. A high detection rate means more people with TB will be put on treatment and cured, thereby breaking the transmission by undiagnosed infectious people with TB, leading to less TB disease and death in the population.
TB case detection is also used as a planning tool for the NTP. For example, forecasting TB notifications needed to meet detection targets will help in procuring sufficient TB diagnostic platform supplies and ensuring that they are available to all in need of TB diagnosis.
Reaching all people with TB with quality diagnostic services is an important goal for national and global policy makers. The numerator, total number of new and relapse TB case notifications, can be analyzed as a trend over time on its own. However, it is more powerful when compared to the estimated TB incidence to determine the magnitude of the gap between the number of people with TB expected and the number detected.
Trends in TB case detection can be used to monitor progress toward achieving national targets to eliminate TB, assess access to WHO-recommended rapid diagnostics (WRDs), and identify weaknesses in recording and reporting systems. Marked changes in the trend should be reviewed in conjunction with any specific events that may have occurred (e.g., increase/decrease in active case finding, establishment of new diagnostic facilities, expanding TB services through private sector or natural disasters that disrupt TB services) and the impact of other disease outbreaks, like COVID-19. This indicator, in conjunction with other indicators, especially bacteriological confirmation and treatment success rate, will provide a picture of the cascade of TB care in the country which will help stakeholders understand the extent to which the TB program is ‘losing’ people with TB along the care pathway. This indicator is limited to the national level only because the denominator is a national-level estimate; however, the numerator can be collected at subnational levels.
Below are examples (for illustrative purposes only) one can use when presenting this indicator. These charts provide important information but will provide more insight if viewed along with additional contextual information, including age, sex, and key program activities.