Assisting countries to implement the WHA resolution on MDR-TB

1. TB/HIV Core Group meeting Geneva, November 3-4, 2009 Assisting countries to implement the WHA resolution on MDR-TB The Global Laboratory Initiative Karin Weyer, WHO-STB, GLI secretariat John Ridderhof, CDC, GLI chair

2. Global Laboratory Initiative Platform of coordination and communication, providing the required infrastructure, focused on TB laboratory strengthening, in the areas of: • Global policy guidance (norms, standards, best practices) • Laboratory capacity development • Interface with other laboratory networks, enabling integration • Standardised laboratory quality assurance • Coordination of technical assistance • Effective knowledge sharing • Advocacy and resource mobilisation

3. GLI structure & governance WHO Stop TB Department Stop TB Partnership GLI Secretariat GLI Secretariat GLI Working Group GLI Core Group Evaluates, approves, governs projects; Advises GLI Secretariat GLI Partners Committee Advises and approves strategic agenda of GLI; Monitors project progress Technical Working Groups Laboratory strengthening roadmap Priority projects and activities Time limited Partner approach Human resource development strategy Laboratory biosafety Laboratory accreditation Other

4. Key GLI activities ~100.000 smear lab centers200.000-300.000 personnel ~8.000 advanced diagnostic centers40.000 – 50.000 personnel • Knowledge sharing • Coordinating TA, training • Communication technologies • - Online knowledge resource network • Guidance • Laboratory policies • Laboratory manuals • Training materials • Resource mobilization • National roadmap advice 28 SRLs supporting 150 NRLs >70 GLI Members WHO GLI Office • Assurance activities • - Coordination of EQA • Equipment specifications • Global accreditation system • Monitoring/evaluation • Interface connection • Matchmaking projects between countries and implementing partners • National “roadmaps” • Advocacy • Other disease networks GLI Network 7 STP WGs Technical Agencies Other Laboratory Networks Other Diseases Capacity building (expanding SRLN, building diverse and flexible national, regional, international consultants base, systematic and structured training)

5. GLI strategic priorities • Accelerating evidence-based policy development on diagnostics and laboratory practices • Promoting a structured framework/roadmap for TB laboratory strengthening within the context of national laboratory plans at country level • Developing a comprehensive set of tools, norms and standards based on international standards and best-practice • Advancing laboratory strengthening through global, regional and local partnerships • Developing multi-level laboratory human resource strategies to address the capacity crisis • Accelerating new diagnostics into countries

6. Accelerated uptake of new MDR-TB diagnostics in 27 countries, 2009 - 2013 (additional 15 planned by 2012) • State-of the-art commodities (instruments, tests, reagents) funded by UNITAID • Leverage other local partners to address non-commodity components (infrastructure, training, etc.) • Long-term mentoring and TA: in-country hands-on support to optimise technology and knowledge transfer, closely linked to capacity building • Full ownership of MOH, NTP, Laboratory • Integrated laboratory approach (notably TB and HIV) • Adjustment based on growing evidence ('learning by doing')

7. Funding for essential instruments, reagents, supplies • Coordinate and manage procurement and delivery • With FIND, engage industry to ensure affordability and sustained price decreases • Collaborate with WHO Pre-qualification to include diagnostics • Policies, norms international standards • Participate in lab assessments • Provide long-term, on-site monitoring • Develop indicators and tools for M&E • Negotiate with partners to ensure lowest prices • Ensure customer support in place • Share know-how from product development process • Provide long-term, on-site mentoring for technology transfer

8. Recipient countries Category 1: start in 2009 Category 2: start in 2010 Category 3: start in 2011 8

9. Total 27 27 25 25 Countries 6 * Targets calculated as a % of estimated MDR-TB burden: 80% for most countries; 35% for India and 60% for Zambia and Cameroon

10. Country partners • American Society for Microbiology • Centers for Disease Control and Prevention • Johns Hopkins University • GHESKIO • Global AIDS Programme • GTZ • KfW Bank, Germany • KNCV • Ministeries of Health, through NTPs • Partners in Health • PEPFAR • OGAC • Project Hope • ICRC • The Global Fund • The Union • USAID • WHO Supranational Reference Laboratory Network • …

11. Future scale-up • EXPAND-TB • 15 additional countries by 2012 • Other low-income, high-endemic countries • Adoption of EXPAND-TB model with other funding sources and other laboratory initiatives (eg. HIV, Malaria, H1N1) • Middle-income, high-endemic countries • Two-pronged approach (manufacturers and laboratory networks) in innovative PPM models • Acceleration of GLI human resource development plan • At least 50 global consultants • At least 50 long-term, on-site mentors • Up to 20,000 laboratory technicians with advance skills • MOH responsibilities in revised human resource plans & strategies

12. Global targets met for MDR-TB patients diagnosed and provided with appropriate treatment under international standards of care Patient care Drugs Diagnostics