Upload
alexandro-winham
View
214
Download
1
Tags:
Embed Size (px)
Citation preview
Progress in implementing the Stop TB Strategy and the Global Plan to Stop TB, 2006-2015
Update of the Working Group on MDR-TB
Thelma Tupasi, Chair of Working Group on MDR-TB
From DOTS to the Stop TB StrategyBuilding on Achievements for Future Planning
Meeting of 22 High Burden Countries and Core Groups of the Stop TB Partnership30 October 2006, La Maison des Polytechniciens, Paris, France
Outline
• Goal of the Global Plan 2006-2015 – Launched Jan, 2006
– To enroll on treatment 800,000 MDR-TB patients from 2006 to 2015
• MDR-TB in the new Stop TB strategy – Launched March 2006)
– To mainstream management of MDR-TB in TB control programmes ensuring access to rational treatment for ALL cases diagnosed with MDR-TB
Outcome of the Fifth Working Group meeting, May 12, 2006, Atlanta, US
Four major challenges to scale up MDR-TB management were identified
-Political commitment at country level and resource mobilization-Human resources-Capacity to diagnose all cases of MDR-TB-Drug management of second-line TB drugs
Challenge 1: Increased and sustained political commitment
to scale-up sound TB control programmes
Two growth projections for scaling up MDR-TB management
0
50
100
150
200
250
300
350
400
2000 2001 2002 2003 2004 2005 2006 2007 2008
Nu
mb
er
of
ap
pli
cati
on
s
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
Nu
mb
er
of
pati
en
ts
GLC-reviewed applications Applications: Scenario 1 - Steady growth
Applications: Scenario 2 - Rapid growth GLC-reviewed patients
Patients: Scenario 1 - Steady growth Patients: Scenario 2 - Rapid growth
Challenge 2: Human resources
•Limited number of consultants trained and Limited number of consultants trained and experienced in assisting on MDR-TB experienced in assisting on MDR-TB
managmentmanagment
•Quantity of properly trained human resources Quantity of properly trained human resources needed for scaling up MDR-TB management needed for scaling up MDR-TB management
at country level is unknownat country level is unknown
Challenge 3: Laboratory capacity
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
Cases estimated detected with MDRTB
with estimated 45% case detection rate
with estimated 45% case detection rate
with estimated 5% DST coverage
with estimated 5% DST coverage
Source: WHO/STB/THD
•
Challenge 4: Drug management
Limited quantity of quality-assured manufacturers and products
High cost of second-line TB drugs
Market of second-line TB drugs needs to become more robust
Outcome of the Fifth Working Group meeting, May 12, 2006, Atlanta, US
Revitalize the Working Group in order to face these challenges:
-To create several subgroups within the WG:- Resource mobilization and advocacy- Research - Drug management- Focal person on laboratory needs for MDR-TB management- Infection control (created in October 2006, after the meeting of the WHO Global Task Force on XDR-TB).
-To produce an operational plan to scale up MDR-TB according to the Global Plan and the emerging challenge of XDR-TB (underway)
Progress in addressing the challenges for operationalizing the Strategic Plan of the WG
• Sustained commitment to scale up– Business plan for the GLC developed by WHO
Working Group Secretariat thanks to generous support of USAID
– Board of the GFATM agreed to fund GLC operations under a cost-sharing scheme. First disbursement expected in 2007.
– UNITAID gave green light for funding second-line TB drugs for MDR-TB management, operationally through GFATM and directly through GLC
Major progress in the political commitment to manage MDR-TB in several HBCs
• China: GFATM approved pilot project for 4,000 patients
• India: • WHO Guidelines for programmatic management of drug
resistant TB adapted• First application for MDR-TB management in two states
reviewed by GLC 1st November, 2006 • Plan of at least one MDR-TB project in 20 states by 2010
• Russia: • Project to treat 7,500 MDR-TB patients in 12 oblasts
approved by GFATM. • Ten applications under review/ to be approved by the GLC. • Major progress in laboratory capacity to diagnose drug
susceptibility testing.
• Eight high burden TB countries: GLC-supported Programmatic MDR-TB management
Scaling up of Programmatic MDR-TB treatment through the GLC
0
5
10
15
20
25
30
35
40
2000 2001 2002 2003 2004 2005 2006
Projects approvedOct 2006 – 40 projects
Almost 23'000 patients
approved for enrolment
Almost 23'000 patients
approved for enrolment
Countries with GLC approved projects
Domestic or other donor support• Armenia• Belize• Burkina Faso• Costa Rica• Estonia• Guinea• Haiti• India*• Jordan• Cambodia*• Lebanon• Lithuania• Latvia• Mexico• Nepal• Rwanda• Syria• Tunisia
GFATM support• Azerbaijan• Bangladesh*• Bolivia• DR Congo*• Dominican Republic• Ecuador• Egypt• Georgia• Honduras• Kenya*• Kyrgyzstan• Mongolia• Moldova• Nicaragua• Peru• Philippines*• Paraguay• Romania• Russia* • El Salvador• Timor-Leste• Uzbekistan
Total: 40 countries – 22 working with GFATM
= More than 23,000 MDR-TB patients
GLC applications under review• 6 regions in Russian
Federation (GFATM)
• China (GFATM)
• Kazakhstan (non GFATM)
• Uganda (non GFATM)
• India (both GFATM, other donors and domestic resources)
Status of GLC collaboration in high TB burden countries as of October 2006.
GLC approved:National TB Programs:
• Bangladesh• DR Congo• Kenya• China• Russian Federation• The PhilippinesNon-NTP• India• Cambodia
GLC under consideration
National TB Program:• India
Non-NTP• Uganda
GLC application underway
• Myanmar
Status of PMTM in high TB burden countries as of October 2006.
NTP:• Brazil, • DR of the
Congo,*• Mozambique, • Philippines,*• South Africa, • Russian Fed*• Thailand
GLC approved NTP:• India• China• Bangladesh• KenyaOperational Study• CambodiaNot NTP• Uganda• India in New Delhi
Status of PMTM funding in high TB burden countries as of October 2006.The three major
obstacles • weak laboratories, • lack of funding • lack of qualified staffGFATM funded DRS • Cambodia, • Nigeria • Zimbabwe GFATM funded MDR-TB
management • Kenya • Philippines
GFATM has approved funding for both DRS and MDR-TB control in 7 HBCs
• Bangladesh, • China, • DR of Congo, • India, • Indonesia,• Mozambique • Russia..
Progress in addressing the challenges for implementing the Global Plan and new Stop TB strategy
• Human resources– Second course of MDR-TB consultants, Latvia, Nov,
2006– First MDR-TB training workshop in Africa, Dar-es
Salaam, Oct, 2006.– Generic training modules for case finding and
management under development in the Philippines – Online training module for MDR-TB management
produced by World Medical Association, based on WHO Guidelines with Eli Lilly support
– SEARO MDR course Feb 2007
– country training courses: Philippines, Korea – the PIH course
Progress in addressing the challenges for implementing the Global Plan and new Stop TB strategy
• Laboratory capacity– To be reported by the DOTS expansion
Working Group
– expansion of the SRL
– planned training courses for FLD/SLD DST in conjunction with the SCLS
– Drug Resistance Survey
no data
estimates
sub-national surveys
countrywide surveys
Coverage of Anti-Tuberculosis Drug Resistance Surveillance
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2006. All rights reserved
Drug Resistance Survey in HBCs
• 11 had carried out nationwide DRS by 2006– Philippines – Ethiopia – Tanzania
• Six high burden countries are expanding regional coverage of drug resistance surveys – India, China and Russia have all made major progress – China is planning a nationwide survey in 2007
• Indonesia has its first drug resistance survey underway• Afghanistan, Nigeria, Bangladesh and Pakistan have no
DRS and except Afghanistan plan to carry out surveys.
Cumulative DRS population coverage by WHO region - expected 2007
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
AFR AMR EMR EUR SEAR WPR
WHO region
Pop
ulat
ion
cove
rage
Progress in addressing the challenges for implementing the Global Plan and new Stop TB strategy
• Drug supply– UNITAID agreed to fund the WHO prequalification
programme, including all TB drugs – Three major meetings, funded by BMGF, held with
manufacturers in Russia and China to promote WHO prequalification,
– Update on WHO Prequalification project• 7 seven manufacturers applied• 13 dossiers submitted • 1 manufacturer WHO GMP approved• no product yet WHO approved
Subgroup on Research• Officially established in July 06
• Several institutions involved:– KNCV (Chair), CDC, PIH, MRC-South Africa,
University of Alabama-US, TRC-India– Secretariat in WHO/STOP TB
• 4 meetings by teleconference and 1 in person (this week)
• First task: to develop a new prioritized research agenda on drug resistant TB– first draft ready and circulated for comments
Acknowledge
• The work of the Working Group and the WHO Secretariat has been possible thanks to the generous funding of:
– BMGF– Eli Lilly Inc– DFID– USAID