Stop TB Partnership

Part III - Partnership Action to Achieve Goals

The Stop TB Working Groups, together with the Secretariat, will be responsible for the Partnership action required to achieve the Partnership’s goals for 2015 and lay the foundation for eliminating TB by 2050.

Part III of the Global Plan to Stop TB provides summaries of the strategic plans for 2006 - 2015 for each Working Group and for the Stop TB Partnership Secretariat.

The seven working groups of the Stop TB partnership were established to ensure that effective action to combat TB takes place in a planned, coordinated and efficient manner. Working groups are organized around specific areas of activity:

Each working group has the following functions:

  • to map activities in its specific area, including activities by different partners, policy and research developments, opportunities for further action, and resource needs;
  • to assist countries to plan, implement, and monitor coordinated action;
  • to report to the Stop TB Partnership Coordinating Board and the Partners’ Forum on the progress, constraints and assistance required; and
  • to coordinate with other partners, working groups, or committees to ensure synergy of activities.

IMPLEMENTATION WORKING GROUP PLANS

The activities of the Stop TB Partnership’s three implementation working groups reflect the implementation of the Stop TB strategy. The aim of the DOTS Expansion Working Group is to assist countries in improving access to high quality DOTS, a key pillar of the Stop TB strategy. This provides a core foundation for the additional elements of the Stop TB strategy regarding multidrug-resistant TB (Working Group on DOTS-Plus for Multidrug-resistant TB) and HIV-related TB (TB/HIV Working Group). The DEWG plan therefore provides the starting-point for the DOTS-Plus and TB/HIV plans, which are supplementary and complementary to the DEWG plan.

The activities of the three implementation working groups provide the foundation for the efforts of the Advocacy, Communications and Social Mobilization Working Group to strengthen strategic communication and social mobilization for improved TB control in countries. The plans of the three implementation working groups will also pave the way for effective implementation of the new tools expected to become available through the working groups on new diagnostics, new drugs and new vaccines.

In each of the Partnership’s implementation working groups, country-level implementation will be guided by the Partnership’s mission to ensure that every TB patient has access to effective diagnosis, treatment and cure, and in particular the recognition that service delivery must take account of the needs of the poor and vulnerable. There is no universal, "one-size-fits-all" solution to the problems that poor TB patients face across the world in accessing high-quality TB services. Each country needs to understand who the poor and vulnerable are, investigate the barriers they face in accessing services, take action to overcome these barriers, harness the resources required to sustain these actions and monitor progress towards equity targets (see Box 5, p. X). Similarly, country-level implementation will need to be guided by epidemiological analysis of other risk groups.

Steps to ensure TB infection control in health care and congregate settings are crucial in interrupting the chain of transmission in settings where people (especially those living with HIV) may be at increased risk of TB, including sometimes multidrug-resistant TB. The TB infection control measures promoted by the three implementation working groups include those recommended for health care settings and prisons.

NEW TOOLS WORKING GROUP PLANS

Introduction

New tools to control TB are critical to achieving the Partnership’s goal of reversing the TB epidemic and eventually eradicating the disease by 2050. In areas of high HIV/AIDS prevalence and rising drug resistance, the TB epidemic is overwhelming current drugs and diagnostics. Furthermore, we cannot hope to achieve the long-term vision of TB elimination without effective new vaccines to drain the reservoir of latent infection. Together, the three working groups on new tools are working to meet these challenges and provide better technologies for preventing TB, and speeding the process of diagnosis and treatment, especially in Africa and Eastern Europe, where TB/HIV and MDR-TB make TB control tremendously difficult.

Cross-cutting issues

There are many cross-cutting issues and synergies in the development and application of new tools.

A primary shared interest is in basic research to address fundamental gaps in the science and understanding of the biology and pathogenesis of Mycobacterium tuberculosis. Current investment in basis tuberculosis research is inadequate to sustain the pipeline of discovery. The Stop TB Partnership is united in advocating for increased investment in fundamental scientific research on tuberculosis to fortify the foundations of knowledge that will lead to future major advancements in the field.

The establishment of the clinical trials platform for the evaluation and demonstration of new tools in national TB control programmes is essential. Additionally, new technologies should be applied synergistically to secure a cumulative epidemiological impact as well as more effective and simplified management of TB control.

Addressing poverty is another key cross-cutting issue. The new tools working groups recognize the need to develop new technologies that will be affordable in developing countries, where the bulk of the TB burden lies. Creative intellectual property mechanisms that protect the public health sector and enhance access to new technologies by underprivileged patients are being implemented.

Expectations for 2006 - 2015 and beyond

Currently there are 15 diagnostics, 27 drugs, and 12 vaccine candidates in the research and development pipeline. By 2006, the first new diagnostics for culture and sensitivity testing, with a shorter response time, will be introduced; by 2010, new rapid diagnostics that are more sensitive than microscopy will be available for use at clinic level. The first new drug for TB will be launched by 2010, and by 2015, we will be on the verge of an entirely new regimen of novel chemical entities that will shorten treatment to one to two months. Starting in 2015, newgeneration TB vaccines will be available. New diagnostics, drugs and vaccines to fight latent disease will be available between 2012 and 2018 to help us move towards the eventual elimination of TB.

Synergy with implementation working groups and Secretariat

The new tools working groups are engaged in active discussions and collaboration with the implementation working groups to evaluate and demonstrate new technologies in national TB control programmes. The Working Group on New TB Diagnostics and the DOTS Expansion Working Group are already collaborating in demonstration projects for new technologies.

With regulatory approval of new tools expected in the next five years, a plan for incorporating these new technologies into current TB control, or "retooling", is urgently needed. Historically, significant time lags between the creation of new tools and their adoption in the field have delayed patients’ access to the best technologies to fight TB. The Partnership Secretariat and all seven working groups will develop a concrete plan to address:

  1. the prompt approval of new tools for adoption by WHO and in countries;
  2. purchasing mechanisms; and
  3. the training of health care workers and national TB programmes who will use and administer these new tools in the field.

New mechanisms will ensure smooth and rapid transition of new research and development tools directly to the field. Additionally, a budget will be allocated to ensure that these activities can be carried out and new technologies can be promptly adopted.

As new technologies and tools for TB control come on-line, the Partnership’s Global Drug Facility plans to integrate their delivery into the overall package it offers. The GDF will need to negotiate concessional pricing of new technologies, and sustain the reputation of the Partnership and Secretariat for supporting the provision of high-quality, low-cost TB control interventions. Between 2008 and 2011, GDF systems will be prepared for the introduction of new drugs and new diagnostics, and possibly TB/HIV treatments packaged together. In a parallel effort, the Working Group on New TB Vaccines will initiate collaboration with the Global Alliance for Vaccines and Immunization (GAVI), the newly established International Financing Facility for Immunization and the Expanded Programme on Immunization (EPI) to develop plans and mechanisms for swift introduction of new-generation vaccines as they become available (approximately 2013).

The Stop TB Partnership Secretariat will encourage and support the development of new procedures in order to improve the collaboration between the groups, and will facilitate progress towards the common goal of TB control.

ADVOCACY, COMMUNICATIONS AND SOCIAL MOBILIZATION WORKING GROUP PLAN

The Advocacy, Communications and Social Mobilization (ACSM) Working Group will liaise with the Stop TB Partnership’s implementation and new tools working groups, national TB programmes, civil society, patients and affected communities to bring about sustainable political, behavioural and social changes to advance the Working Group’s vision. The ACSM Working Group’s strategic vision is to achieve TB-free communities by:

  1. The Global advocacy: creating the political accountability and social pressure required to shape policy agendas and mobilize US$56 billion from 2006 to 2015 for TB control and new tool development; and
  2. Country-level ACSM: establishing and funding evidencebased and innovative country- and community-driven ACSM activities to effect sustainable societal and behavioural change at the national, subnational and individual level, aimed at ensuring access to treatment and care for all, particularly the poor, vulnerable and hard-to-reach populations.

STOP TB PARTNERSHIP SECRETARIAT STRATEGIC PLAN

The Secretariat aims to ensure that, by enabling partners to work together, the Partnership has greater positive impact on global TB control than if individual partners worked alone. The Secretariat’s strategic vision is that the full and active contribution of all partners to TB control and poverty reduction will lead to a TB-free world by 2050. Its mission is to empower partners in sustained action, to create synergies and to catalyse innovation, in order to achieve the Partnership’s 2015 TB targets linked to the MDGs. The Secretariat is a facilitator and broker for partners, a stimulator of innovation, a communicator on progress and an ambassador for Stop TB. It is not a programme manager, a funding agency or a policy-maker. The Secretariat is housed in the World Health Organization.