Global Drug Facility Technical Assistance update February

Ethiopia was one of the first countries to achieve a 70% case detection rate and 85% treatment success rate (TSR) among new cases, making it one of the first countries to halt and start reversing the incidence of TB. The Stop TB Partnership’s GDF participated in the country’s Midterm Review (MTR) from 16 to 30 January 2017, whose main goal was to assess the status of the implementation of the National Strategic Plan (NSP) 2013-2020. Under the current NSP, the Ethiopia National TB and Leprosy Program (NTLP) has registered several achievements including, sustained government contribution for TB control (23% increase in TB funding since 2014); expansion of the TB laboratory network and infrastructure at all levels; attaining incidence and TSR targets high enough as to halt and begin to reverse TB incidence; a relatively low TB/HIV co-infection rate, with 82% of TB patients being tested for HIV; and adequate availability of anti-TB medicines at facility level. However, in order to build upon these achievements, the program needs to increase government funding for TB control, especially when it comes to taking over the financing of anti-TB medicines. The MTR therefore recommended immediate prioritization of reprogramming and utilization of GF TB funds to prevent their loss. In addition, in order to increase case finding it was recommended to expand the geographic coverage (currently at 28%) and scope of Xpert technology (i.e. to include first-line drugs testing for presumptive cases). During MTR, GDF led the assessment of procurement and supply management (PSM), including TB medicines forecasting, supply planning, procurement processes and early warning system (EWS), and discussed key findings and agreed on recommendations.

The Stop TB Partnership's Global Drug Facility (GDF) conducted a mission in Mozambique from 12 to 18 February 2017. GDF supported the NTP in planning the procurement of first-line (FLD) and second-line TB drugs (SLD) for 2017 and 2018, based on accurate quantification. GDF also supported the NTP in reviewing the Procurement and Supply Management (PSM) transition plan for the introduction of the new paediatric formulations and the shorter MDR-TB regimen. Furthermore, GDF conducted a 3-day quantification training, using the new version of the QuanTB tool, for the NTP and Central Medical Store staff in order to improve capacity for proper forecasting, quantification, supply planning and early warning system (EWS). Around 13 participants attended the quantification training and it resulted in the updated countrywide quantification, using the most recent data, giving a real overview of the situation of TB medicines in Mozambique. During the training participants also discussed PSM challenges and possible solutions that could be immediately and effectively implemented. GDF will continue to collaborate with the NTP of Mozambique through remote support to ensure regular review of proper quantification, adequate implementation of the EWS and timely delivery of TB commodities.

The Stop TB Partnership's Global Drug Facility (GDF) participated in the External Review Mission to Timor-Leste from 20 to 24 February 2017. During the visits to health facilities, GDF highlighted the importance of an inventory control card and the need to institute an improved inventory management system for the monitoring of medicine usage. In November 2016, GDF had trained three staff from Timor-Leste during a workshop in Bangkok on the use of the QuanTB tool as an early warning system to monitor national stock status and prevent stock-outs and overstock. Since then, NTP has used the QuanTB tool to monitor stock levels and case enrollment for regular quantification, identify early warning indicators and take the necessary actions to address them. During the mission, GDF also supported the country in reviewing the transition plans for introduction of the new paediatric formulations and the shorter MDR-TB regimen.

The Stop TB Partnership's Global Drug Facility (GDF) conducted a mission to Senegal from 16 to February 2017. GDF supported the National TB Programme (NTP) to develop a transition plan for the introduction of the new paediatric formulations, which will allow the country to provide a more suitable and efficient treatment for children suffering of tuberculosis (TB). To this end, GDF is offering Senegal a one-year grant to cover the needs of the TB treatment for 869 children, starting from September 2017. GDF also reviewed the scale-up plan for the use of the shorter MDR TB treatment and highlighted the need for urgent orders of some second-line TB medicines to avoid MDR-TB treatment interruption. To address the needs of one confirmed case of XDR-TB and 3 presumptive cases of pre-XDR-TB which were identified in 2016, GDF is assisting the country to expedite the procurement of new medicines to ensure patients have access to adequate treatment. This mission also supported the country in quantifying the needs for other TB medicines and GeneXpert cartridges, to define adequate procurement schedules and establish an early warning (alert) system to prevent stock outs and expiries. GDF is supporting the NTP to explore flexible options available within the national legislation, to ensure the procurement of essential and life-saving medicines and to mobilize the required political support to enact procurement strategies adapted to the small volume of TB health products.

The Stop TB Partnership's Global Drug Facility (GDF) conducted a mission in Cambodia from 6 to 15 February 2017. The objectives of the mission were to provide technical assistance to estimate the drug needs for the next year, with a view of ensuring an uninterrupted supply of quality-assured TB drugs and diagnostics and developing a national Procurement and Supply Management (PSM) plan for the transition to the shorter MDR-TB regimen, the new child-friendly medicines and new or repurposed drugs. Several supply scenarios were discussed in order to accelerate the introduction of new drugs and regimens and to ensure that the required funding is available. GDF also provided hands-on technical support to the NTP in other PSM-related areas, such as strengthening the Logistics Management Information System for Essential Medicines in Cambodia, reviewing the Essential Medicine List and the reinforcement of the pharmacovigilance system.