TB Epidemiological Review 2023 Timor-Leste

Overview

Timor-Leste’s National TB Programme (NTP) is known for fast uptake of new recommendations into routine programming, innovative and sustainable solutions on various aspects of TB service delivery. There has been highest political commitment to drastically reduce the TB burden in the country with His Excellency Prime Minister of TimorLeste, General Taur Matan Ruak, signing the pledge in September 2021 that envisions comprehensive support and actions to "End TB" in Timor-Leste by 2025–26. Since the previous review in 2019, Timor-Leste’s NTP has made remarkable progress in improving TB prevention, diagnosis and treatment services, and TB disease surveillance. Compared to the 2019 review, the use of molecular tests for the diagnosis of TB has increased by 4–5 times. Several new initiatives such as systematic screening, triaging and fast-tracking of persons with TB symptoms at high workload health facilities and mobile van with digital X-ray machine with CAD, and a pilot TB vulnerability assessment survey have been rolled out successfully. A nationally representative drug resistance survey has been completed and it showed that the true burden of DR-TB is very low than the previous estimates. Active case finding at hard-to-reach areas has led to detection of a significant number of TB cases. The National TB Prevalence survey is currently underway and is likely to be completed by the end of 2023. The major gap in the NTP’s efforts at reducing the TB burden in the country has been a persistent gap between the estimated incidence and case detection, with only about 50–60% of the incident cases detected and treated. Like in many other countries around the world, COVID-19 pandemic has aggravated this gap in Timor-Leste. Due to the pandemic-induced disruption in the health services and health care seeking behaviour, in 2020 and 2021, the TB case detection in the country dropped by 25% when compared to 2019 levels. However, in 2022, there has been a rebound with 64% more TB cases detected than in 2021, 25% more when compared to 2019 (pre-COVID time). Sustained high levels of case detection will be needed to reverse the impact of COVID-19.