DILI, 06 november 2024 (TATOLI) – Timor-Leste notified 6171 tuberculosis (TB) cases in 2023, the highest on record, according to the World Health Organization’s (WHO) Global Tuberculosis Report 2024, released on October 29. While this increase may initially appear concerning, it reflects the impact of intensified surveillance and enhanced diagnostic systems implemented in one of the world’s highest TB burden countries. This year’s figure marks a continued rise from 5,370 cases reported in 2022—a 64% increase from 2021 and a 27% increase compared to 2019.
Despite the rise in detected cases, Timor-Leste has made substantial progress in TB control, reducing TB-related deaths by 55% from 2015 to 2023. The declining trend in mortality has accelerated in recent years, with a 48% reduction achieved between 2021 and 2022, and a further 33% reduction between 2022 and 2023.
Timor-Leste ranks second in TB incidence within the WHO South-East Asia Region and is among the top countries globally, with an estimated incidence rate of 498 cases per 100,000 population.
In 2023, over half (51%) of reported cases were bacteriologically confirmed, a key indicator of effective diagnosis. Additionally, 45% of cases were tested with rapid diagnostics at the time of diagnosis, reflecting a substantial increase in access to molecular testing tools such as GeneXpert. This marks a notable shift from 2019, when fewer than 10% of cases were confirmed through molecular diagnostics.
“Strengthening and innovating systems for rapid TB diagnosis and treatment was a critical priority for Timor-Leste to control transmission,” said Dr Arvind Mathur, WHO Representative. He highlighted that, starting in 2021, the country’s top leadership and Ministry of Health, with support from WHO and partners, undertook targeted initiatives to expand diagnostic capacity, improve case reporting, and enhance treatment adherence—marking a transformative period in the country’s TB response.
In October 2021, then-Prime Minister Taur Matan Ruak pledged to eliminate TB in Timor-Leste by 2025, setting ambitious targets: a 50% reduction in TB incidence and a 75% reduction in TB-related deaths from 2015 levels. This commitment followed a ‘TB vulnerability assessment’ survey with WHO support, which pinpointed towards malnutrition and tobacco use as significant risk factors.
Building on this foundation, Timor-Leste took decisive steps to accelerate TB diagnosis. In 2022, the country introduced the Line Probe Assay (LPA), a rapid test to detect resistance to essential TB drugs, including rifampicin, isoniazid, fluoroquinolones, and pyrazinamide.
Soon after, Timor-Leste launched a ‘One-Stop Mobile Diagnostic Van,’ equipped with digital X-ray with Artificial Intelligence (AI) integration for digital X-ray analysis; TrueNat molecular test, capable of diagnosing TB within an hour and screening for rifampicin resistance, and electronic medical records. Supported by WHO and the Global Fund, this mobile unit enabled early TB detection through community outreach.
In 2023, the mobile diagnostic van was further complimented with 5 ultra-portable digital X-ray units with AI for enhancing diagnostic precision and efficiency.
Additionally, with the first-time implementation of bi-directional screening for TB, COVID-19, influenza-like illness (ILI), and severe acute respiratory infections (SARI), 26,680 individuals were screened. This approach, which checks patients for multiple diseases regardless of the initial reason for testing, led to the enrollment of 2,457 eligible patients in the program, resulting in the rapid diagnosis of 81 TB cases.
These layered advancements have been instrumental in strengthening Timor-Leste’s TB response, as highlighted by the Global Tuberculosis Report 2024, which shows significant progress in TB case confirmation.
The Global TB report also highlighted the continued link between HIV and TB, with 87% of diagnosed TB cases in 2023 having a known HIV status. The report also stated that 91% of the cases in Timor-Leste were of lung TB. Importantly, around 4% of cases were among the paediatric age group.
Mathur said that while there has been substantial progress, the journey to TB elimination is far from over. “This fight is not only against an ancient and resilient bacterium alone but also against underlying factors like undernutrition, smoking, alcohol use, diabetes, and HIV, which continue to drive TB’s spread in Timor-Leste.
Globally, the TB landscape remains challenging. The WHO report indicates that approximately 8.2 million people were newly diagnosed with TB in 2023, the highest number since 1995. The number represents a notable increase from 7.5 million reported in 2022, placing TB again as the leading infectious disease killer in 2023, surpassing COVID-19.
TATOLI
Source: WHO
