August 2001, issue of the Stop TB Communiqué

STOP TB COMMUNIQUE

Issue 12, August 2001

1. NEWS FROM THE STOP TB PARTNERSHIP SECRETARIAT

• Stop TB Partners' Forum

The First Stop TB Partners' Forum—"50/50: Towards a TB-free future"—will be held in Washington, DC from 22 to 23 October 2001. The Forum, which will be hosted by the World Bank, celebrates 50 years of progress in the treatment of TB and looks forward, highlighting the fact that there are only 50 months remaining to reach the global TB control targets. Partners in the global movement to Stop TB are in the process of engaging leaders in development and civil society, including ministerial delegations from countries with the highest burden of TB. To date, delegations of 7 high-burden countries and 15 partner organizations have confirmed their participation.

The Stop TB Partners' Forum has 5 stated objectives: (i) to report on progress since the Amsterdam Conference on Tuberculosis and Sustainable Development (March 2000) /stop_tb_initiative/amsterdam_conference/default.asp; (ii) to further accelerate efforts to operationalize the Amsterdam Declaration to Stop TB /stop_tb_initiative/amsterdam_conference/default.asp#declaration; (iii) to address the urgent issue of TB and HIV/AIDS /wg/TB_HIV/; (iv) to launch the Global Plan to Stop TB; and (v) formally to endorse the supporting mechanisms for the Stop TB partnership. Expected outcomes include consensus on the way forward for the global partnership; reinforced commitment to implement the Amsterdam Declaration to Stop TB in order to reach global targets for TB control by 2005; and strengthened partnership activities to stop TB.

Further information is available from the Stop TB Partnership Secretariat at mailto:stoptbinfo@who.int.

!STOP PRESS: A separate e-mail communication will be issued shortly to announce the launch of the Stop TB Partners' Forum webpage on the Stop TB web site, which will contain regular updates about preparations for the Forum.

New Stop TB partner Health & Development Networks (HDNet) will provide electronic networking and communication support to the Stop TB Partners' Forum. A virtual, moderated discussion forum on TB has been launched to provide a channel for input to the Partners' Forum. The discussion forum, which was launched last week, will initially focus on 3 key areas: (i) progress in implementing the Amsterdam Declaration /stop_tb_initiative/amsterdam_conference/default.asp#declaration;
(ii) where do we go from here?: a Global Plan for TB; and (iii) TB among HIV-infected persons.

To join the forum: join-stop-tb@healthdev.net; to send a message to the discussion forum: stop-tb@healthdev.net. Discussion archives are available at http://archives.healthdev.net/stop-tb/. A project description about the discussion forum is available from http://www.hdnet.org.

• Stop TB Coordinating Board

A meeting of the Coordinating Board will immediately follow the Partners' Forum on 24 October. A Working Committee of the Board has been established to support the Stop TB Partnership Secretariat in the preparations for Board meetings and related background documents. A teleconference of the Working Committee on 9 August considered the outcomes of the GDF Technical Review Committee; the agenda for the Partners' Forum; nominations to the Coordinating Board; and the operations of the Board Working Committee.

Further information is available from the Stop TB Partnership Secretariat at mailto:stoptbinfo@who.int.

• Global TB Drug Facility (GDF) and interim GDF pilot projects /GDF/Index.htm

Second Round Applications

The Secretariat received 19 country applications and 2 applications from nongovernmental organizations (NGOs) for the second round of GDF applications. The second round GDF Technical Review Committee (TRC) convened from 25–26 July 2001 in Geneva to prioritize these applications. Seven countries were approved, 7 are under consideration, and 4 were not approved. One country did not apply for drugs, and the 2 NGO applications are being used to develop a mechanism for supporting NGOs with drugs. Second round applicants will be able to receive drugs from September 2001. The Secretariat is currently organizing GDF country visits for some second round countries.

The TRC also discussed the applications procedure for the GDF, the monitoring procedure for the GDF, and GDF products. The Stop TB Partnership Secretariat will prepare background documents outlining the conclusions of these discussions. The third round application form and notes are currently being revised in line with recommendations from the TRC, partners, and applicant countries. An application form for NGOs is also being developed for this round.

Further information is available from the Stop TB Partnership Secretariat at mailto:stoptbinfo@who.int and gdf@who.int.

Stop TB Partners' Survey

A directory of the Stop TB partners will shortly be available on the Stop TB web site. Directory entries contain contact information as well as information on partners’ ongoing and planned work in tuberculosis. Data from the directory are being used to prepare the Global Plan to Stop Tuberculosis, which will be unveiled at the Partners' Forum. Beyond its role in the Global Plan, the directory will be an important tool in helping the Secretariat support individual partners in their work, and in enabling partners more easily to draw upon each other's resources.

The general public will be able to see basic contact information and brief descriptive text for each partner. Partners having submitted an entry will have full access to the Directory, and will be sent a user ID and password in the next few days.

Some partners have yet to submit entries, which can be made directly at our Partners' Directory where more detailed instructions can also be found. Thanks to the many partners who have participated so willingly.

Any questions should be directed to Joel Brenner mailto:joel_brenner@hms.harvard.edu.

• World TB Day 2002

Planning is under way for next year's World TB Day on 24 March 2002. A contest to develop a theme will be announced shortly.

• WORKING GROUPS /wg/

Global Working Group on TB among HIV-infected people /wg/TB_HIV/

The ProTEST Initiative: lessons learned and next steps

The major burden of HIV is borne by developing countries, where 95% of HIV-infected people live. At the end of the year 2000, it was estimated that out of the global total of 36.1 million people living with HIV/AIDS (PLWH), 25.3 million (70.1%) were in sub-Saharan Africa. It is further estimated that of the 24 countries in the world with an adult HIV seroprevalence rate in 1999 above 5%, 23 are in sub-Saharan Africa. In 8 of these countries (all in Southern Africa), the adult HIV seroprevalence rate is above 15%. Since HIV is the most powerful known risk factor for reactivation of latent tuberculosis infection to active disease, and TB is a leading killer of people infected with HIV, there is strong epidemiological justification for TB programmes and HIV programmes to collaborate.

The ProTEST initiative, aims to Promote HIV voluntary Testing as a key to a more coherent response to TB in high HIV prevalence settings. This will contribute to the development of a strategic approach that can be promoted as an expansion in scope of the internationally recommended TB control strategy. The current network of projects includes sites in Malawi, South Africa, Uganda, and Zambia. WHO and UNAIDS are coordinating the ProTEST Initiative in collaboration with several role players, including the National Department of Health in South Africa, NORAD, DFID, USAID, Canadian MRC, and several NGOs operating at country level.

The Projects have been under way in Malawi, South Africa, and Zambia since 1999. The lessons learned so far include: 1) the pilot projects have been shown to improve TB treatment outcomes in the districts where the projects are located; 2) the introduction of rapid HIV tests has facilitated increased uptake of VCT; 3) the development of district committees of HIV/AIDS/STI and TB appears to strengthen both TB and HIV/AIDS services; 4) the participation of district management is critical to success of TB and HIV collaborative activities; 5) training and support of core district staff is essential for successful roll-out; 6) the adherence to preventive therapy with INH and cotrimoxazole is poor and presents a challenge to implementation.

The next steps include: 1) modelling of impact of better TB and HIV programme coordination on the combined burden of TB and HIV; 2) evaluation of the costs and cost-effectiveness of coordinated TB and HIV control efforts; 3) development of national plans for roll-out, which may include developing TB and HIV training districts; 4) exploring the possibility of adding the prevention of mother-to-child-transmission of HIV and the use of HAART to the package of interventions made available as part of the Initiative. The first meeting of the global working group on TB among HIV-infected people recommended that WHO and UNAIDS should continue to support the ProTEST Initiative in collaboration with partners in: a) identifying more sites and brokering more funds to establish more projects; b) convening a writing group to develop operational guidelines for establishing ProTEST and similar projects.

A scientific panel of the Working Group on TB among HIV-infected people will meet on 12–13 September to establish guidelines on how to operationalize the TB and HIV control collaboration.

DOTS-Plus for MDR-TB

Country missions are being carried out to Costa Rica, Kazakhstan, and South Africa to assess the feasibility of DOTS-Plus pilot projects.