Overview of TB in Tanzania

Tuberculosis Response in Tanzania
Tanzania is among 30 high TB and TB/HIV burden countries globally. In Tanzania, TB control is fully integrated into the primary health care services. Overall, in 2019, there were 8,446 health facilities of which 70% were government facilities which provide TB services. Countrywide, there were 3,512 (41%) TB treatment centers and 1613 (19%) Diagnostic centres and among the diagnostic centres there were 238 GeneXpert, 969 stand-alone microscopy laboratories and 391 x-rays services. The coverage of treatment centres is 1.2 per 10,000 population, and with diagnostic centres is 2.3 per 100,000 population.
Epidemiology
In Tanzania, TB affects mostly men, and a lesser number of women mostly in productive ages. The ratio of male to female has been constant ranging between 1.6 in 2016 and 1.4 in 2019. The TB incidence rate is estimated at 237/100,000 population which is equivalent to 137,000 incident cases. In the last four years, the incident rate has declined steadily with an accumulated decrease of 18% from 2015 to 2018, with an annual decrease rate of above 4%. The decrease in incidence rate is also accompanied by a drop in TB deaths; thus, from 2015 to 2019, the TB deaths declined by 28%. Both the incidence rate and TB death decrease indicates that Tanzania is on course to achieve the End TB Strategy milestones for 2020 and 2025.
TB Notification
TB notification has shown steady increases over the last five years, whereby a 32% increase has been achieved from 2015 in which 62,000 cases were notified to 82,224 cases in 2019. The number of notified TB cases started to increase by 6% in 2016 to 9% in 2019. The increase in the notification and declining incidence led to increased treatment coverage rate to 57% in 2019 compared to 37% in 2015. With the increasing trends in TB notifications, the country has observed a decrease in the number and proportional of missed TB cases as shown in figure1. However, the proportion of new and relapse bacteriological confirmed TB cases had declined from 41% in 2016 to 35% in 2019
Collaborative TB/HIV
Tanzania has been implementing TB/HIV collaborative activities since 2006. HIV testing among TB patients has increased from 93% in 2015 to 99% in 2017 and was maintained until 2019. The proportion of HIV positive TB cases started on ART increased from 85% in 2015 to 99% in 2019. On the other hand, the proportion of TB patients who are co-infected with HIV has decreased over time i.e. from 36% in 2015 to 24% in 2019. Estimated mortality among TB/HIV patients is still high, at 40% despite high HIV testing and ART coverage.
MDR/TB
The burden of  MDR-TB is low, with a prevalence of was 0.85% among new cases and 4.6% among re-treatment cases (2017 Drug Resistance Survey). With scale up of GeneXpert test, the notification of drug-resistant cases has increased from 178 cases in 2015 to 534 cases in 2019, but this is still below the national estimates.There has been a significant decrease in the gap between detected and enrolled in second line treatment from 33% in 2015 to 3% in 2019. Treatment success of MDR-TB patients is at 82.6% for the 2017 cohort. These results are attributed to the decentralization of MDR-TB treatment services
Treatment success
The country has maintained a high treatment success rate at 90%, and in 2019 the treatment success rate was at its highest at 91%. Deaths decreased from 6% in 2015 to 4% in 2018. Further, the treatment completion rate increased from 55% to 59% during the same period.
Childhood TB
There is a rise in the proportion of children among all notified cases from 7% in 2015 to 15% in 2019. However, the trend shows that most of the children were notified through score chart and chest x-ray as such 75.9% were diagnosed clinically while only 14.8% bacteriologically confirmed and the ratio of TB notification for 0-4:0-15 years old is below the recommended ratio of 1.5 to 3 suggesting under-diagnosis in children <5 (and probably a degree of over-diagnosis in older children 5-14y. The country introduced the child – friendly anti-TB formulations in 2018