April 2002 issue of the Stop TB Communiqué

STOP TB COMMUNIQUE

Issue 19, April 2002

1. NEWS FROM THE STOP TB PARTNERSHIP SECRETARIAT

The Global Fund to fight AIDS, TB and Malaria
The Global Fund has now announced which applications for support is has approved for its first round of disbursement. TB projects have received 16% of the total funds available, with a further 15% going to projects which address these diseases in combination. 13 countries were approved for support for TB or TB and HIV projects – China, Ethiopia, Ghana, India, Indonesia, Democratic People’s Republic of Korea, Moldova, Mongolia, Panama, Rwanda, South Africa, Sri Lanka and Thailand. The total funds granted for TB and TB/HIV projects were USD 53,774,825 in the first year and USD 285,173,233 in total.

Advocacy and Communications
A Stop TB meeting in support of Community Mobilisation was held in Newark, New Jersey (USA) on 25-26 April 2002. The meeting was hosted by the National Tuberculosis Centre of the New Jersey Medical School. The meeting was organised by the Stop TB Partnership Secretariat and attended by partners including IUATLD, ALA, CDC, the Global Alliance for TB Drug Development, the New Jersey Medical School Tuberculosis Centre, Results International, Treatment Action Group (TAG), the Task Force for Child Survival and Development (TFCSD), the World Bank, and WHO.

The objectives of the meeting were :

• To establish a common understanding and direction on Stop TB Community Mobilisation;
• To develop a process for assessing possible communications and advocacy activities in all 22 High Burden Countries (HBCs);
• To identify HBCs for in-depth review and implementation of communications & advocacy projects in support of national DOTS Expansion efforts;
• To develop an operational work plan for Community Mobilisation in HBC's.

During the two-day meeting the group discussed and identified potential HBCs for in-depth review and implementation of advocacy and communications projects in support of national DOTS Expansion efforts. The group also agreed on the need for systematic and comprehensive country analysis in all HBCs to identify the various stages and likely timeframe for implementing advocacy and communications activities in support of DOTS Expansion efforts.

A work plan was developed to outline the steps, establish timeframes and determine the international support required for carrying out the specific activities, including financial needs.

2. NEWS FROM THE STOP TB WORKING GROUPS /wg/default.asp

DOTS Plus Working Group

Working Group on DOTS-Plus for MDR-TB
The Meeting of the Working Group (WG) on DOTS-Plus for MDR-TB was held in Tallinn, Estonia, 10-12 April 2002. The meeting was attended by 152 members of the WG from 32 countries and a variety of partner agencies. It was structured to have discussions on the following subjects: progress of the WG, progress of the DOTS-Plus pilot projects in the seven countries approved by the Green Light Committee (GLC), convergence between the GLC and the Global Drug Facility (GDF), clinical-epidemiological aspects of MDR-TB, monitoring of MDR-TB patient treatment, fitness of MDR-TB bacteria, research priorities, and administrative aspects. The most important conclusions and recommendations included the following:

• Continue to implement projects in different settings in order to define policies for proper management of MDR-TB cases. Economic aspects to be prioritised in any future project.
• GLC and GDF should slowly and cautiously converge in some areas. Due to the obvious differences between the two bodies, the process should begin with a clear exploration of the most important aspects which could progressively be commonly addressed. A recommendation in this direction should be provided to the STB-CB.
• Transfer of technology for 2^nd line drugs: the current 2^nd line drugs are likely to be used for the next several years. Therefore, it is key to promote technology transfer, possibly to developing countries, to ensure wider production of good-quality generic products. WG and WHO should continue to encourage generic manufacturers to enter this segment of the market.
• A Core Group composed of 7 members was established via a process of nominations and consensus approval. It includes: WHO, Chair of the WG, and Chair of the GLC on a fixed basis, and 2 country representatives (Philippines and Estonia), one agency (University of Alabama) and one donor (USAID) on a rotation basis.
• Treatment monitoring policy should be finalised as soon as possible to allow international comparison and homogenous assessment of results.
• A prioritised research agenda should now be finalised through a consultative process, via a questionnaire administered to all members.
• The next meeting of the WG will be held in 2003 either in the Philippines or in Korea. The Core Group will make the final decision upon consulting with the two country representatives.
• WG to draw on experience to further develop training material and processes into generic training material and guidelines for use in other countries.
• Drug resistance surveillance should be a pre-requisite for DOTS-Plus implementation.

The final report from the meeting will be available in the upcoming weeks.

Working Group on TB/HIV
The GFATM announcements are excellent news for the recently formed TB/HIV "community" and its Global Working Group. Following the Nairobi workshop, organised by WHO HQ/AFRO Stop TB and sponsored by CDC and USAID, Ethiopia was able to insert a TB/HIV component into its country application. This, together with the rest of the TB proposal was accepted and funded without further revision.

South Africa has taken full advantage of their experience with the ProTEST projects, and assembled a proposal for HIV/AIDS which includes a major expansion of TB/HIV activities. This expansion will build on the foundation of the government’s work on TB over the past decade and the support they have received from the Belgian government. It will enable development of joint TB/HIV activities in every province of the country.

Malawi's proposal which requires some revision, but is in the list for fast-track review, focuses on anti-retroviral drug delivery and foresees close co-operation between the HIV/AIDS control programme and the activities of the NTP.

Zambia’s TB proposal has been shortlisted for deferred funding pending clarification and adjustments to their proposal.

DOTS Expansion Working Group
TB proposals from five countries, China, Ethiopia, India, Indonesia and Thailand, among the 22 High Burden Countries (HBCs) have been selected by the GFATM for support for its first round of disbursement. While this is excellent news for the selected countries, other HBCs also need attention and support. Their proposals will need further development for submission. We would thus like to encourage technical partners, as part of the Global DOTS Expansion plan, to support countries to revise or develop new proposals in order to ensure that countries with the greatest need receive funds.

The third STOP TB DOTS Expansion Working Group Meeting will be held on 6 October 2002 in Montreal, Canada in conjunction with the 33^rd IUATLD World Conference on Lung Health. The objectives of the meeting are to review the status of TB control and DOTS expansion in the world, its constraints and challenges, and to identify rapid solutions. This special workshop will allow all participants to get acquainted with the status of TB control efforts and DOTS expansion in the world. The entire audience attending the 33^rd IUATLD World Conference will have a chance to listen to the country representatives, including those of the 22 HBCs, and selected speakers presenting their TB control perspectives. It is a unique opportunity to update everyone on where countries stand today and to build solid alliances within the Global DOTS Expansion Plan (GDEP).

This workshop will be preceded on 5 October 2002 by a meeting, limited to invited members of the DOTS Expansion Working Group, at which representatives of the 22 HBCs and the technical and financial agencies working with them to control TB will discuss progress, plans and financial needs to achieve the 2005 targets.

Working Group on TB Diagnostics
The TB Diagnostics Initiative has been asked by Partners in Health to take the lead in the development of diagnostic protocols and studies associated with the Gates-funded project on MDR TB being carried out in Peru. The first of these studies will be a collaborative prospective study of drug susceptibility testing methods with the National Institutes of Health/Cayetano Heredia University in Lima, Peru.

A critical meeting to set study plans was held on October 18-20, 2001 in Lima. Training opportunities for laboratory staff at the trial site have been identified, and industry collaboration in training assured. Trial protocols have been drafted and trial implementation plans were discussed in February, 2002 in Lima. Principal investigators to produce a plan of action including the necessary authorization of the Peruvian Ministry of Health. A second PI, Fernando Llanos, director of the National Institutes of Health, has been added to the protocol.

A laboratory support network for diagnostics trials and methodological research is being planned for 22 high disease burden countries. Preliminary work includes the preparation of standardised protocols and training materials. A pilot project for capacity strengthening will be conducted at trial sites in 4 countries. A visit to Afghanistan will be carried out in April to help restructuring of TB services there and to determine the feasibility of incorporating operational research into TB laboratory activities from the start.

Global Alliance for TB Drug Development
On April 8-9, the Global Alliance for TB Drug Development (TB Alliance) cosponsored in collaboration with the CDC and NIH a Workshop on Longer Acting Rifamycins at the US National Institutes of Health in Bethesda, Maryland. The meeting gathered some 30 scientists from academia, public research institutes and industry, together with the Scientific Advisory Committee of the TB Alliance. The group reviewed all rifamycins with particular attention to the latest data and research findings regarding their efficacy in HIV + TB patients in widely spaced intermittent regimens, their interactions with current antiretrovirals, the protein binding effects on the pharmacokynetics and pharmacodynamics of the compounds, and the mechanisms of action that could enhance the sterilizing activity of the rifamycin family -- such as crystallography of targets and apoptosis.

3. News from the Global TB Drug Facility

Technical Review Committee Meeting, Geneva, 22-23 May 2002

From 22 - 23rd April the Technical Review Committee (TRC) of the Global TB Drug Facility met in Geneva to review applications submitted to the GDF for the third round of support. 14 applications were submitted to the GDF for this round of support, thirteen (13) from country programs and one (1) from a Non-governmental Organization. All applications received were reviewed and discussed by the TRC. The recommendations of the TRC will be forwarded to the Stop TB Co-ordinating board for their endorsement and final decision.

Drug Management Meeting, Washington, D.C., June 6-8 2002

1) In-country drug management was identified by Stop TB partners during the last year as an immediate need in most developing countries, to assure that TB drugs and supplies are available when patients need them.

2) Co-hosts for the meeting are Stop TB, Management Sciences for Health and KNCV. Drug management experts will be facilitating the sessions.

Objectives:

1. Identify the major strengths and weaknesses in relation to in-country drug management of TB drugs
2. Develop country specific joint action plans with countries and partners on what is needed to be done, and by whom, in relation to TB drug management
3. Identify indicators for routine monitoring of TB drug management
4. Identify the characteristics of good procurement practice for national and global procurement of TB drugs
5. Identify a core set of TB products for the GDF and countries

Expected Outcomes:

Each country will develop a specific action plan with TB lead partners for improving drug management in their countries. The plan will contain a description of the activity, resources and technical assistance needed, timeline for implementation and who will be responsible for individual activity implementation and completion.

4. Calendar of Events /events/archive.asp

The 4^th World Congress on Tuberculosis (TB) will be held at the Marriott Wardman Park Hotel in Washington, D.C, U.S.A. on June 3-5, 2002. This meeting will evaluate the state of the global TB epidemic since the last Tuberculosis World Congress in 1992, review the status of TB research and identify research gaps.

Topics covered will include fundamental, translational and operational research. This meeting is for global TB control officials, TB researchers, health systems services researchers, policymakers and funders, as well as infectious disease and pulmonary physicians.

Hotel, abstract and meeting details: www.niaid.nih.gov/dmid/tuberculosis/tbcongress

• 55th World Health Assembly, Switzerland
  http://www.who.int/gb/
  Geneva, Switzerland, May 2001

• American Society for Microbiology (ASM) 102nd General Meeting
  http://www.asmusa.org/mtgsrc/gm2002prelimprogtoppage.htm
  Salt Lake City, Utah, USA, May 19-23

• 4^th World Congress on Tuberculosis
  http://www.niaid.nih.gov/dmid/tuberculosis/tbcongress
  Washington, D.C., USA, 3-5 June

• IUATLD Conference of the African Region Durban, South Africa
  June 10-14
  (Programme to be announced)

• ESM 23rd Annual Congress of the European Society of Mycobacteriology
  http://www.esm2002.com/
  Dubrovnik, Croatia, June 23-27

• 1st FEMS Congress of European Microbiologists
  Ljubljana, Slovenia, June 29 - July 3

• 6th International Meeting on Molecular Epidemiology and Evolutionary Genetics in Infectious Diseases
  Paris, France, July 24-27

• The World of Microbes
  http://www.iums-paris-2002.com/
  Paris, France, July 27 - August 1

• 3rd European Congress on Tropical Medicine and International Health
  http://www.kit.de/tropical2002/
  Lisbon, Portugal, September 8-12

• 12th European Respiratory Society
  http://www.ersnet.org/2/2/2_2.asp
  Stockholm, Sweden, September 14-18

• 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy
  http://www.icaac.org/ICAAC.asp
  San Diego, California, USA, September 27-30

• DOTS Expansion Working Group Meeting
  Montreal, Canada, October 5-6

• IUATLD 33rd World Conference on Lung Health
  http://www.iuatld2002.org/
  Montreal, Canada, October 6-10

2003

• 13th European Congress of Clinical Microbiology and Infectious Diseases
  http://www.escmid.org/preview.html?meetings.html
  Glasgow, Scotland, UK, May 10-13

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The Stop TB Communiqué is issued monthly by email to global partners in order to share information on progress in the global partnership movement to stop TB. Partners are invited to submit news items, progress updates, comments and suggestions to reynoldsk@who.org. Stop TB Partnership Secretariat, World Health Organization, 20 avenue Appia, CH-1211 Geneva 27. Visit the Stop TB website at www.stoptb.org. The site is sponsored by the American Lung Association www.lungusa.org. Stop TB is a partnership hosted by the World Health Organization www.who.int.

Throughout the Stop TB Communiqué, "DOTS" is used as a brand name in its broadest sense as an umbrella term for all DOTS-based strategies, including DOTS-Plus for MDR-TB and expanded strategies to address TB/HIV.

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