Putting an End to TB where are the opportunities and what are the challenges?

1. Putting an End to TB where are the opportunities and what are the challenges? Strategy meeting on Resource Mobilization for the Global Fund to Fight AIDS, TB and Malaria 28 January 2013, Amsterdam Sophie müller Advocacy officer Stop TB Partnership Secretariat

2. Setting the stage "the burden of tb"

3. The burden of TB – 2011 figures

4. Progress in TB stillneeds to take off • 3 million TB patients nevergettheir TB detected & treated • Huge gaps in MDR-TB diagnosis and treatment • Onlyhalf of HIV-positive TB patients receive ART & only 40% of TB patients are tested for HIV

5. What's new in TB?

6. The window of opportunityishere • We have proven interventions and approaches • to detect and provide carefor all TB patients • universal testing for drug resistance and several fold increase in coverage of services for drug resistant TB • Full coverage of TB/HIV care package to all HIV-associated TB patients, including TB testing of all PLHA and ART for all HIV positive TB patients • For the first time in four decades, we have new tools

7. GeneXpert – a powerful and affordable new diagnostic • A new diagnostic tool endorsed by WHO in December 2010 • A two-hour rapid diagnosis of TB and rifampicin-resistant TB • Agreement between PEPFAR, USAID, UNITAID and Bill & Melinda Gates Foundation in August 2012 to expand access to GeneXpert • GeneXpert is now available in over 70 countries at affordable prices (cartridges prices were reduced from US $16.86 to US $9.98)

8. Bedaquiline – first new TB drug in more than forty years • FDA approved bedaquiline on 31 December 2012 as part of the treatment regimen for multidrug-resistant tuberculosis (MDR-TB) in adults

9. Other key developments • For the first time in 40 years, a coordinated portfolio with11 new or repurposed anti-TB drugs are in clinicaltrials • Several new diagnostic tests are in development, including a point-of-care test • The development of a new TB vaccine: Bacille Calmette Guerin (BCG) from 1921 is the only vaccine but unreliable against adult pulmonary TB. • 11 vaccine candidates are currently in the pipeline – with the possibility of at least one new TB vaccine by 2020

10. Estimatedresources

11. Financing of TB – key facts Gap US$ 3 billion Needs US$ 8 billion Annual financing for TB = 5.5% of the overallneeds for TB implementation = 90% of all external financing = 16% of all GF disbursements External US$ 480 million Global Fund US$ 440 million Composition of TB financing (2011) drug-sensitive ~US$ 30 Cost of TB drug MDR-TB ~US$ 2,600

12. Key challenges • Weakvoice of TB • We are not ambitiousenough. Whatisneeded are ambitiousscale-up plans for TB! • We are "mortgaging" our future • 3 million people hadtheir active TB not detected and hence not treated in 2011 -> but each TB patient risksinfecting on average 10-15 people • The negligancetowardsdrug-sensitive TB is the main reason for the emergence of drug-resistant TB • 380.000 MDR-TB patients were not treated in 2011 • Being more efficient • Prioritization of countries where the highest impact canbeachieved • Scale-up of drug-sensitive TB interventions • Roll-out of GeneXpert • FollowPEPFAR'sBlueprintrecommendation of targeting HIV-associated TB and providing ART for all TB patients • In countries where HIV and TB are prevalent, testing for both should be provided to everyone

13. Key advocacy messages

14. Key messages • TB patients rely on the Global Fund • Thanks to the Global Fund, almost 10 million TB patients werediagnosed & treated – millions of livesweresaved • 90% of all availableexternalfinancing for TB came from the Global Fund • Missedopportunity – acttoday, not tomorrow • We have neverbeen as close to making a real difference in TB thanks to new approaches and new tools • If wedon'tacttoday, an expansive and virtuallyuntreatabledisease (XDR-/TDR-TB) isemerging • Smart investment • TB is curable • TB care delivers - proven track record of saving lives and growing economies • TB is an inexpensivedisease to treat and the costs stop after six months

15. Thankyou Sophie Müller Stop TB PartnershipSecretariat mullers@who.int