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DEWG progress report 2009

DEWG progress report 2009. DEWG meeting GENEVA 13-14 October 2009 Léopold BLANC TBS/STB/WHO Secretary of the DEWG. Global TB estimates and notification - 2007. Estimated number of cases. Cases reported DOTS.

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DEWG progress report 2009

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  1. DEWG progress report 2009 DEWG meeting GENEVA 13-14 October 2009 Léopold BLANC TBS/STB/WHO Secretary of the DEWG

  2. Global TB estimates and notification - 2007 Estimated number of cases Cases reported DOTS All forms of TB Greatest number of cases in Asia; greatest rates per capita in Africa 9.27 million (139 per 100,000) 5.6 million (80 per 100,000) 4.1 million 2.6 million (63%) New Smear positive Multidrug-resistant TB (MDR-TB) 30,000 511,000 HIV-associated TB 1.4 (15%) 300,000

  3. % of MDR among new and re-treatment TB cases, 2007 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 2009. All rights reserved

  4. Countries that had reported at least oneXDR-TB case by end April 2009 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 2009. All rights reserved

  5. Countries testing Tuberculosis Patients for HIV 2007 Proportion of TB patients tested for HIV Key No reported activity < 15% 15% to 50% More than 50% 135 countries reporting 16% of all TB cases tested. More than 75%

  6. TB/HIV intervention scale-up, Africa* TB patients tested for HIV HIV+ TB patients on CPT HIV+ TB patients on ART *Africa has 85% HIV+ TB cases globally

  7. DOTS Progresses the link with implementation DEWG 2004

  8. Treatment success on target (>85%), case detection stalling after years of expansion Estimated case detection (%) of sputum smear + cases Treatment success (%) among sputum smear+ cases 80 Target 85% DOTS 63% in 2007 60 Whole Country 40 20 0 1990 1995 2000 2005 2010 Europe: 70%, Africa: 75%, Americas: 75% Africa: 47%; Europe 51%; East. Med: 60%

  9. The stop TB strategy not broadly implemented • TB/HIV: TB systematic screening of HIV positive persons implemented only in few places • MDR-TB management limited to small projects except in few countries • Involvement of non public health care providers in TB control still limited (scaling-up PPM in only few countries) • Human resources crisis in Africa in particular • Community involvement still timid in many countries. Patients groups just starting • Patient charter available in very limited number of countries

  10. Way forward to attain MDGs • Need to accelerate efforts in TB control by: • aiming at more than 85% cure (with new drugs?) • aiming to 100% case detection (universal access) • shorten diagnostic delay (cut transmission, reduce suffering): need indicator of delay in diagnostic • A proposed framework to identify required actions to improve case detection and reduce delays

  11. DEWG progress report 2009 • 10 outputs defined in the DEWG plan of action • Reinforcing support to countries • Monitoring Global plan implementation (WHO TB control report and Stop TB partnership report) • Funding TB control in countries • Health system strengthening • Human resource strengthening • Involvement of communities and patients • TB and poverty • Control of childhood TB • PPM • Introduction to New Approaches and new Tools (INAT)

  12. What is ? 1. Reinforcing support to countries • Established in 2007 by the DEWG, hosted by WHO/HQ • Objectives: • facilitate access to high-quality technical assistance • encourage TA planning at all levels, especially national level • improve TA efficiency by ensuring that needs are met while minimizing redundant TA • promote capacity-building at all levels in terms of TA planning and training of consultants according to international standards • Tool: TBTEAM web site (http://www.stoptb.org/wg/tbteam/ta/) • Partners: ATS, BMG Foundation, CDC, DAHW/GLRA, Damien Foundation, FHI, GDF, GIP ESTHER, GLC, The GF, HSI, ICN, John Snow, Inc., KNCV, MSH, PIH, PATH, PSI, Project Hope, RIT/JATA, Samm Health International, TBCAP, The Union, UNDP, USAID, World Bank, World Vision International, PEPFAR, GLI.

  13. 1. Reinforcing support to countries How has progressed?

  14. 2. Monitoring & Evaluation Main achievements 2009 • Task force on impact measurement: • Strengthening routine surveillance • Regional workshops for 21 EUR, 9 SEA and 14 LA countries. • Country missions to reassess the estimates of TB in 3 HBC • Implementation of prevalence surveys for TB disease • 22 Global Focus countries (16 HBC) for prevalence surveys • Vietnam and the Philippines completed survey and analysis • 3 training workshops on development of survey protocol for 7 HBC • Bangladesh completed the field operations • 6 protocols for surveys were reviewed • Myanmar started survey field operations • Review of Methods used to produce epidemiological estimates • of the epidemiological burden of TB, TB/HIV and MDR-TB.

  15. Data reported (online*) in 2009 Data reported (online*) in 2009 Follow-up queries based on systematic review of data distributed to NTP managers of 22 HBCs, to allow discussion this week *See: http://www.stoptb.org/tme/

  16. 2. Monitoring & Evaluation Main achievements 2009 • Follow-up on Berlin Declaration: the 18 priority countries in Europe have prepared or are preparing plan to strengthen TB control and target M/XDR-TB … • Follow-up meeting on the declaration of TB emergency in Africa (Maputo 2005): review in WHO Regional committee Kigali 3 September 2009 with high commitment from ministers • Programme reviews organized in 8 countries in 2009

  17. 3. Funding TB controlMain achievements 2009 • GF round 9: • 500M for 2 years. • 53 countries applied • 30 approved (60%)

  18. 4. Health System Strengthening Main achievements 2009 • HSS framework used in GF proposal preparation and in programme reviews • PAL implemented in 12 countries (expansion phase) and more than 40 countries are at different stages of implementation or preparation of PAL implementation.

  19. 5. Human resources Main achievements 2009 • Planning the development of human resources for health for implementation of the Stop TB Strategy - A handbook (WHO7HTM/TB/2008.407) • Revised set of training modules for Management of TB at Health Facility level (revision to reflect the Stop TB strategy. Includes a module on infection control) • New page on HRD on the WHO Stop TB Department's website • A total of 94 countries, including 14 HBCs have conducted a recent HRD needs assessment • 90 countries, including 14 HBCs reported having a comprehensive plan for HRD related to TB control

  20. 5. Human resources activities Main orientation 2010-2011 • HRD issues figures prominently in the Beijing call for action in the • WHA resolution and in the Stop TB partners forum • The 62 WHA URGES all Member States: to achieve universal access to diagnosis and treatment of M/XDR-TB……. by means of…. • (d) making available sufficiently trained and motivated staff in order to enable diagnosis, treatment and care of tuberculosis including multidrug-resistant and extensively drug-resistant tuberculosis, as an integral part of efforts to address the overall health workforce crisis; • Stop TB Partnership Partners Forum, in Rio de Janeiro March 2009, Joint WG meeting (TB/HIV, MDR-TB, GLI, DEWG) recommend: • Establish a taskforce to address the cross cutting issue of human • resources across the working groups. TB must be part of the broader global health workforce movement.

  21. 6. ACSM SubgroupMain achievements 2009 • Documentation of ACSM Best Practices (pre-launch in Cancun). • Document on how to work with media for correct reporting of key TB messages to a wide audience. • Worked with WHO/TME team to revise ACSM indicators in TB control questionnaire. • Set criteria for TBTEAM experts roster for ACSM TA providers to ensure quality and consistent TA of entire Component 5.

  22. 6. ACSM Subgroup Main orientation 2010-2011 • Provide guidance on M&E for ACSM and community involvement (Rio Recommendation). • Build further evidence, to support strategic planning, design, implementation and evaluation of ACSM interventions. • Consolidate ACSM in TB prevention and care in countries (Strategic plan, focal persons, partnering approach). • Advocate ACSM as cross-cutting issue affecting all components of Stop TB Strategy by showing evidence and partnering approaches.

  23. 7. TB & Poverty SubgroupMain achievements 2009 Advocacy Debate on ‘Free Diagnosis’ in Rio Forum Systematic review underway on interventions addressing socio-economic conditions which can potentially be replicated in TB control Research Patient cost measurement tool piloted Mainstreamed measurement of equity impact through NDWG Blueprint and TREAT TB Support Global Indigenous STOP TB Strategy agreed, presented at UNFPII Trained programme managers in 24 Chinese provinces on equity and gender (population coverage c. 1 billion)

  24. 7. TB & Poverty Subgroup: Activities to improve case detection and TB care Rio recommendations on availability of free diagnosis for TB suspects Piloted mechanisms to increase equity in access to TB diagnosis in China through elimination of patient up-front payment Supported health systems trial in Malawi and Sudan to increase access to TB and HIV services through close-to-community providers

  25. 7. TB & Poverty Subgroup:Main orientation 2010-2011 Subgroup OVI’s: By 2010 all countries will: Have capacity to monitor extent to which TB control reaches the poor & vulnerable Have key strategies for improving access to TB control for the poor & vulnerable Selected directions for 2010-2011 Promotion of concepts and practical implementation of free diagnosis Papers forthcoming on equity and PPM Recruitment of indigenous TB focal person Assessment of equity in access to MDR services in at least one country

  26. 8. Childhood TB subgroupMain achievements 2009 • Attendance at programme reviews (India, Bulgaria, Romania) and technical assistance in training and national guidelines development (Pakistan, Philippines, Papua New Guinea) • International Training Workshops: • Cape Town, September 2009 • Bangalore/Delhi and Nepal – October 2009 • Post-Graduate course at Union's Europe region conference, Dubrovnik, May 2009 • Post-Graduate course and 3 symposia at the 40th Union's World Conference on Lung Health, December 2009, Cancun, Mexico

  27. 8. Childhood TB subgroup Main achievements 2009 • Work towards updating of the Childhood TB Guidance (document published in 2006); • Five systematic literature reviews completed; one more ongoing • Interim instructions on the use of the existing fixed-dose formulations with new dosing of Isoniazid, Rifampicin and Pyrazinamide • Development of the "Guidance for National TB and HIV Programmes on the Management of Tuberculosis in HIV-infected Children: • Input provided into the update of the Guidelines on INH Preventive Chemotherapy in HIV-infected children (work led by WHO HIV department) • Participation in the update of the Global Plan to Stop TB, specifically addressing research needs for the use of new tools; • Creation of the Childhood TB sub-group of the New Diagnostics Working Group (to be launched in December 2009)

  28. 8. Childhood TB subgroup Main orientation 2010-2011 • Finalize Childhood TB Guidance's revision • TA to countries in developing training material and guidelines • Participation in programme reviews • Post-graduate courses and symposia at the Union's conferences (global and regional) • Research agenda – trials in use of new diagnostics and new drugs in children

  29. 9. PPM SubgroupMain achievements 2009 • ISTC dissemination: 11 National Professional Associations awarded grants to prepare ISTC implementation plans (ATS) • Linking hospitals: Document summarizing guiding principles prepared (KNCV) • Engaging all care providers for TB/HIV collaborative activities: Pilot projects implemented in two countries (Union/FHI) • Documentation of work-place TB and TB/HIV programmes in five countries (WHO) • Documentation on engaging social security organization in TB control in two countries (MSH/WHO)

  30. 9. PPM SubgroupMain achievements 2009 • Documentation for guidance on measuring PPM contribution to TB control (WHO/MSH/Union) • Organized "First consultation on engaging business sector in TB control" (WHO) • Documentation on supply and use of anti-TB medicines in four countries (WHO) • Support and documentation of PPM scale up in India and China (WHO) • Preliminary analysis of PPM components of Global Fund grants (WHO/GF) • Documentation of PPM for MDR-TB management in two countries, and preparation of background paper for Beijing meeting • PPM Newsletter

  31. 9. PPM Subgroup Main orientation 2010-2011 • Development of a PPM tool-box on evidence-based strategies to engage different types of public and private care providers in TB care and control • Organization of the sixth global meeting of the PPM Subgroup • Engaging large hospitals to improve TB case detection and care • In-depth analysis of support for PPM in Global Fund grants to understand and address gaps and weaknesses • Support and assist documentation of PPM scale-up in countries • Regulatory approaches to ensure standardized TB care by non-programme providers – restricting access to anti-TB medicines – setting up certification and accreditation systems

  32. 10. Introducing New Approaches and ToolsMain achievements 2009 Retooling Task Force Dissemination of New Laboratory Diagnostic Tools for TB Control (Dec 2008) Participations in Thematic Track "From Research to Retooling" In STOP TB Partner Forum in Rio The Partnership Coordinating Board (March 2009) Dissolution of the Retooling Task Force Creation of a sub-group on Introducing New Approaches and Tools under the DEWG: The 1st core group meeting: 12 Oct, 2009

  33. 10. Introducing New Approaches and Tools Improving case detection and TB care • Facilitate country planning to prepare for coming new approaches and technologies to improve case detection through documents and tools developed by the Retooling TF • Promote operational researches or pilot programmes to develop algorithm and approaches to improve case detection

  34. 10. Introducing New Approaches and Tools Main orientation 2010-2011 To be defined soon: • Provide platform to interface the working groups of different areas • Solicit information from NTPs and implementing partners on the challenges being faced • Prioritize and coordinate a concerted responses to the operational challenges indentified • Prioritize operational and evaluation research

  35. TBCAP supported activities APA4 (1 Oct2008 - 30 Sept 2009)

  36. Conclusion • Back to the early years of the DEWG Year 2001 : preparation Year 2002 : implementation Year 2003 : scaling up Year 2004 : accelerating actions Year 2005 : broadening the scope of interventions ………………………………….. Year 2010: achieving higher and earlier case detection, maintain high cure

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