Stop TB Partnership Communiqué
Issue No.25
October 2002

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News from the Stop TB Partnership Secretariat (web site)

Note of Condolence

It is with great sadness that the Partnership reports the death of Dr Yunes. Dr Yunes was a Stop TB Coordinating Board member, representing Brazil as a high-TB-burden country. He was a well-respected professor at the School of Public Health of the University of Sao Paulo, and a senior adviser to the Minister of Health. In that function he has been an WHO-EB representative over the last years. He sadly passed away 2 weeks ago, suffering from cancer. A condolence card has been circulated by the Director's office.


Tuberculosis Among Prisoners

The international expert meeting on Tuberculosis Among Prisoners will be held in St Petersburg in November 25-27, 2002. For details on how to participate or for more information about this event, please contact Christina Palm at: christina.palm@kvv.se

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News from the Stop TB Working Groups (web site)

DOTS Expansion Working Group (DEWG)

a. The third DOTS Expansion Working Group (October 5- 6, 2002), Montreal, Canada

The meeting was designed to develop a clear plan to support country activities in each of the 22 high burden TB countries for DOTS Expansion in 2003.

The first day was a closed meeting for the representatives of the 22 high TB burden countries (with the exception of Afghanistan), the main financial and technical agencies, as well as WHO TB staff from the country, regional and global offices.

The second day was an open meeting, attended by around 300 participants.

Conclusions of the meeting were:

  • if current trends continue, the detection target of 70 per cent may not be reached until 2013
  • even if 100 per cent geographical coverage is achieved in the near future, the detection target may not be achievable
  • additional interventions are necessary to increase case detection and notification
  • new case finding methods and improved surveillance are crucial

Participants at the meeting shared their country experiences in TB control. Delegates spoke of the need to expand community care programmes, for TB diagnosis and care to be decentralised by using more primary services, the need to expand Public-Private Mix DOTS programmes and the scaling up of NGO involvement in TB control.

The conclusions of the meeting showed the need to continue to support and facilitate DOTS Expansion in countries, including:

  • national coordination (National Interagency Coordination Committee and CCM)
  • planning and financial support
  • technical cooperation
  • human resources development
  • strengthening of laboratory network (Lab Sub-Group)
  • monitoring and evaluation
  • coordination with other Stop TB working groups

The fourth DOTS Expansion Working Group will meet in The Hague on October 6 or 7 in 2003.

An open session is scheduled for the IUALTD Conference on October 29, 2003.

b. News from Practical Approach to Lung Health (PAL)

PAL monitoring, evaluation and operational researchers are ongoing and the results for the future perspectives of TB control services and their sustainability are promising.

PAL has been implemented with strong political commitment in Morocco, at a regional scale in countries such as Chile and at pilot sites such as in Nepal and South Africa.

An intervention study carried out recently in Morocco reported that the implementation of standardised case management for priority respiratory diseases reduced antibiotic prescription by one-third and drug prescription cost by 20 per cent.

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TB/HIV

A meeting of the Core Group of the TB/HIV Working Group (WG) was held on 24-25 September 2002, at WHO, Geneva, with discussions on the roles and functions, the future work plan and the setting of priorities of the WG.

The core group concluded that in order to accelerate progress of joint TB/HIV activities the following recommendations for priority actions would be made to the WG:

Policy development

  • Guidance and strategy on the management of antiretroviral therapy (ART) in people also requiring anti-TB treatment, to be led by Dr David Cohn, Health Sciences Center, University of Colorado, Denver.
  • Development of systems for delivering ART at district level in high burden countries, to be led by members of the TB/HIV WG, specifically staff from the Stop TB Partnership and HIV/AIDS Dept.
  • The TB/HIV WG to be represented and influence debate at the forthcoming WHO Technical Consultation on Increasing Access to HIV Testing and Counselling 19-21 November 2002.

Country support

  • Technical support to countries for establishing collaborative TB/HIV activities and attracting resources. A protocol development workshop is planned for francophone countries in Africa in November 2002.
  • Support to countries for the phased implementation of collaborative TB/HIV activities beyond the pilot phase. A consultant has been recruited to develop key indicators and targets for the ongoing monitoring and evaluation of collaborative TB/HIV activities.

Information, Education and Communications (IEC)

  • Development and promotion of TB/HIV IEC messages for public, patients and health workers. TB/HIV working group secretariat to consult with the Stop TB Partnership secretariat on this issue.

Other important areas of work include the development of novel approaches to health care delivery and human resource capacity building. A database of research evidence and ongoing TB/HIV collaborative activities is proposed which will identify evidence gaps and help to create a prioritised research agenda.

A third meeting of the TB/HIV working group is planned for spring 2003.

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DOTS Plus

News from DOTS PLUS for MDR-TB

The report of the annual meeting of the Working Group on DOTS-Plus for MDR-TB (10-12 April 2002, Tallinn Estonia) is now available from the WHO Secretariat. The document is titled "DOTS-Plus: Preliminary Results and Emerging Issues" (WHO/CDS/TB/2002.307).

An interactive CD-ROM is also now available which contains:

  1. all WHO documents related to drug resistance
  2. a history of the activities of the Working Group on DOTS-Plus for MDR-TB
  3. all the presentations from the Tallinn meeting
  4. a video commissioned by WHO on the TB epidemic in Estonia.

All participants of the Working Group will receive a copy of the report and the CD-ROM, by post.

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News from the Global Drug Facility (GDF) (web site)

GDF Update

  • In the October edition of the "The Globe and Mail", the GDF was praised for its success in negotiating low prices for TB drugs and upon delivery of the drugs, ensuring that treatment is carried out properly. Canada was honoured with a special medal from the IUATLD to recognise its commitment to fighting TB. The Minister of International Co-operation, Susan Whelan, who accepted the award, said that the GDF has become the cornerstone of the program and it will change the way foreign-aid dollars are spent.
    Please click on the link below to view the full article.
    Globe&Mail_021005.htm
  • GDF was highlighted at the recent IUATLD conference in Montreal, Canada with formal presentations and sessions on how to apply to the GDF and buy drugs from the GDF. A video showcasing GDF achievements in Moldova was also released.
  • The GDF Technical Review Committee will review the fifth Round of applications from 30 October -1 November 2002. The secretariat has received 7 applications for this round (3 new country applications, 1 country reapplication and 3 country monitoring applications for the second year of GDF support). Copies of the GDF application forms as well as NGO application forms are available on the GDF website www.globaldrugfacility.org in French, Russian and Spanish.

Latest Facts and Figures

  • Countries approved for support: 33

    • The GDF has reviewed applications for grants of TB drugs from 42 countries, two NGOs, one federal state, and one public-private partnership initiative. Of these, 33 applications have been approved for support. Of the country applications, one is still under review. All of the countries approved for support have an annual per capita GNP of less than US$ 1,000. The 33 approved applications comprise a total of over 1.6 million patient treatments, of which 1,167,613 constitute drugs for new patients (over 10% of the estimated new cases of TB) and 453,789 buffer stocks for patients. Assuming 85% cure rate in those patients diagnosed and commencing treatment this year, this means 992,471 additional patients will be cured through GDF support.
  • Countries that have received drugs: 11

    Drugs pledged have already been delivered to 11 countries. Drugs for an additional 10 countries have been ordered and should be received in 2002.
  • Countries buying drugs through the GDF: 2

    • A direct procurement mechanism has been established, enabling countries to utilise their own resources to procure drugs through the GDF, benefiting from the low prices and high quality gained by the GDF. Two countries, Peru and Uganda, are now currently negotiating orders of TB products through the GDF Direct Procurement mechanism. 95 countries and over 60 organisations/agencies which are committed to DOTS are eligible to use this mechanism.

  • Grantees whose TB programmes have been monitored: 4

    • The secretariat is currently organising monitoring visits in all countries approved in the first and second rounds. Monitoring visits have already taken place in DPR Korea, Moldova, Myanmar and Kenya. The reports from the monitoring visits will be reviewed for consistency and credibility by independent Desk Auditors. Monitoring reports cleared through the desk audit will be submitted to the GDF Technical Review Committee, which will make recommendations on continued GDF support to the relevant grantees.

  • TB drug manufacturers short listed for pre-qualification: 21

    • The process for the pre-qualification of manufacturers of TB products, initiated in January 2002 by the GDF, and being coordinated by the WHO Department for Essential Drugs and Medicines Policy, is under way. Sixty-seven manufacturers expressed interest in becoming suppliers of TB drugs to the GDF. Twenty-one of these passed initial screening and are being assessed by a team of independent evaluators. Physical site inspections of the manufacturers began in late September. Sites in India, Pakistan, Bangladesh and Malta will be evaluated during the last quarter of 2002, with additional inspections planned for 2003. The first white list of pre-qualified TB manufacturers and products is expected to be published early in 2003.

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Calendar of Events (web site)

For more information on upcoming events, please click on the above link:

November 2002

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New TB Documents (web site)

The following documents are now available by clicking on the above link.

  • Frequently asked questions about the 4-drug fixed-dose combination tablet recommended by the World Health Organisation for treating tuberculosis - WHO/CDS/STB/2002.18
  • Improving TB Drug Management-Accelerating DOTS Expansion - WHO/CDS/STB/2002.19
  • El Control de la Tuberculosis en Prisiones - WHO/CDS/TB/2000.281
  • DOTS-Plus: Preliminary Results and Emerging Issues WHO/CDS/TB/2002.307

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    'Stop TB' - a global movement to accelerate social and political action to stop the spread of tuberculosis around the world. For further information please contact the Stop TB Secretariat at: stoptbinfo@who.int

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