The first Core Group (CG) meeting of the Global Drug-resistant TB Initiative (GDI) was held on 1-2 May in Geneva chaired by Dr Charles Daley. All 16 members of the CG attended the meeting, along with observers from the Global Laboratory Initiative (GLI) and the Global TB Drugs Facility (GDF). On the first day of the meeting, the members were briefed on the how the GDI came to be established and its proposed role, on global progress in scale-up of MDR-TB services, key areas of work for the Stop TB Partnership in 2014 including those of the GDF, and the progress in implementation of regional plans in response to MDR-TB in each of the WHO Regions, and in particular the work of the respective 6 regional Green Light Committees (rGLCs). The second day of the meeting was devoted to the development of strategic priorities and activities of the GDI.
The following areas were actively discussed by the CG members:
- Need to improve capacity to treat MDR-TB patients ensuring alignment with the expansion of diagnostics, especially the rapid molecular tests.
- Low global treatment success rate (48%) amongst MDR-TB patients and specifically the high rates of "lost to follow-up" and "not evaluated", which significantly contribute to the overall low treatment success rates.
- Advocacy for MDR-TB needs to be strengthened for increasing the resources available for the required scale up of services.
- Need for rapid scale-up of second line drug susceptibility testing capacity in order to detect and correctly treat the XDR-TB cases.
- Need for agreed MDR-TB disease burden indicators and their appropriate use.
- Strengthening supply chain systems and access to quality assured second-line drugs through GDF support.
- Need for coordination of technical assistance being provided through the various funding agencies and technical partners.
- The essential need for the involvement of the private sector in programmatic management of DR-TB (PMDT) activities, however as yet this has not received the required attention that it deserves.
Based on the discussions, the following strategic priorities and activities were agreed by the CG members:
- Develop targeted advocacy strategies and resource mobilization for DR-TB management scale-up.
- Facilitate integration and coordination of efforts to align diagnostic services for patients with access to high-quality care.
- Build global consensus on the management of DR-TB for patient centred care delivery ("care for cure").
- Promote strategies to facilitate patient access to high-quality DR-TB care, through a long-term, in-country capacity building approach targeting both the public and private sector.
- Support prioritization of research to generate evidence for PMDT scale-up.
All Task Forces will be led by an identified GDI partner and progress in its work will be monitored by the Core Group on a regular basis.
Professor Charles Daley, MD, elected as Chair of the Core Group of Global Drug-resistant TB Initiative (GDI)
Professor Charles Daley, MD, was elected as the Chair of Core Group of the Global Drug-resistant TB Initiative (GDI) by the Core Group members. Dr Daley has served till recently as the Chair of the global Green Light Committee (gGLC) and brings with him strong clinical and educational background, field experience, leadership, and the ability to bring people together for global scale up of the programmatic management of drug-resistant TB (PMDT).
Dr Daley has worked with drug resistant tuberculosis patients for 20 years. He developed and implemented a national tuberculosis advice line that helped TB programs across the United States manage complicated forms of tuberculosis, including drug-resistant tuberculosis (DR-TB). He participated in the development of the WHO 2008 Emergency Update of the Guidelines for the Programmatic Management of Drug-resistant Tuberculosis as well as the 2011 updates to the PMDT guidelines. Over the past few years, he has provided monitoring and technical assistance support to several high TB/ MDR-TB burden countries including China, the Philippines, Peru, and Kyrgyzstan. He has facilitated several international PMDT trainings aimed at building capacity for scale-up of PMDT. He has also conducted research in countries such as Tanzania, Uganda, Brazil, and Colombia.
Drug-resistant tuberculosis (DR-TB), particularly multi-drug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB) represent significant threats to global TB control efforts and a major public health concern in several countries. Levels of MDR-TB remain worryingly high in some parts of the world, notably countries in Eastern Europe and Central Asia. In several of these countries, up to 32% of new cases and more than 50% of previously treated cases have MDR-TB.
The World Health Organization (WHO) estimates that worldwide 450,000 people developed multi-drug resistant TB (MDR-TB) and at least 170,000 deaths were caused by MDR-TB in 2012. Globally, the overall detection of cases of MDR-TB increased from 29,000 in 2008 to about 94,000 in 2012. However, only around 77,000 eligible patients were actually put on MDR-TB treatment. Despite progress, the number of MDR-TB cases initiated on proper treatment in 2012 represented only 17% of the estimated cases of MDR-TB. Achieving universal access to treatment as envisaged in resolution WHA62.15 requires a bold and concerted drive on many fronts of TB care.
The Global Drug-resistant TB Initiative (GDI) has been recently constituted as a Working Group for drug- resistant TB related issues (DR-TB) replacing the previous MDR-TB Working Group and the global Green Light Committee (gGLC). The main focus of the GDI will be accelerating the global response to DR-TB through a partnership approach with involvement of all key stakeholders.