Like many other countries, Tanzania started rolling out the new optimized child-friendly TB formulation since end of 2017. On March 20, 2018, the Ministry of Health, Community Development, Gender, Elderly (MOHCDEC) and Children through the National Tuberculosis and Leprosy Program (NTLP) launched the use of new pediatric formulation for managing childhood TB.
The event took place in Dar es Salaam region where approximately 80% of all pediatric TB cases are currently being notified and was officiated by the Minister of Health, Community Development, Gender, Elderly and Children, honorable Ummy Ally Mwalimu. In her remarks, the Minister highlighted the need to ensure early detection of childhood TB through systematic screening of all children at all main entry points within health facilities. The need to appropriately manage pediatric TB cases using the improved pediatric formulation currently being provided free of charge was also strongly emphasized.
The event was attended by representatives from WHO, implementing partners such as USAID funded Challenge TB project and Boresha Afya project implemented by FHI 360, representatives from selected private hospitals, District pharmacists, Regional and District TB and Leprosy Coordinators, National AIDS Control Program (NACP), NTLP program officers and other MOHCDEC officials. Stop TB Partnership/GDF’s Regional Technical Advisor for Anglophone region currently based in Tanzania also attended this event.
Stop TB Partnership’s Global Drug Facility (GDF) participated in the 12th TB Program Managers Meeting in the Western Pacific Region held in Manila from March 13 to 15, 2018. Program managers and their representatives from 13 countries in the region attended the meeting, including 3 GDF priority countries Philippines, Vietnam and Cambodia. GDF provided update to participants on the availability of new TB medicines and diagnostics and how GDF and countries can address together the challenges on introduction and roll-out focusing on procurement and supply management (PSM) aspects.
Additionally, GDF presented its technical support to the region, including a regional PSM workshop to be held from May 7 to 11 in Cambodia. GDF also participated in the discussions on sustainable financing and co-financing and highlighted the importance of good planning in ensuring countries have the regulations, legislation and systems to access quality-assured TB medicines at reasonable prices via GDF to avoid stock outs, procurement of poor quality products or procurement at very expensive prices. Although there is still a long way to go on issues surrounding co-financing and regulations, GDF has collected country information to address immediate concerns where GDF may support either to provide cost analysis for comparison or to provide supply information needed by the countries.
Médecins Sans Frontières and the Ministry of Health of the Kyrgyz Republic organized the 7th TB Symposium in Eastern Europe and Central Asia called "Treating Patient, Not Disease: People-Centered Approach," on 1 - 2 March 2018, in Bishkek, Kyrgyzstan.
Stop TB Partnership’s GDF chaired the session on ‘Financing and Procurement Mechanisms’ along with the Head of the Mandatory Health Insurance Fund of the Kyrgyz Republic. At the symposium GDF has organized meetings with the representatives of the national TB programmes of priority countries and international partners to discuss and agree on procurement and supply of TB medicines considering the transitioning period from the donor to state financing. During the country visit, GDF coordinated with NTP and partners the second-line TB medicines forecasting and quantification exercises for the planned procurement through the GF financing. Link to the symposium can be found at: http://msf-tb-symposium.org/en/2018/
At the request of the Pan American Health Organization (PAHO) the Stop TB Partnership’s GDF joined other partners during the TB monitoring mission to Haiti from 11-17 March 2018 as the leader in procurement and supply management (PSM) of TB medicines to assess the current situation, propose improvements and further requirements for technical assistance to the National TB Programme and partners.
The main findings were lack of regulatory environment for registration of products in the country, inadequate quality control and pharmacovigilance. Although efforts have been made to improve TB product management, the capacity of health workers, particularly at peripheral levels, remain insufficient concerning data collection and use of PSM tools resulting in inadequate quantification and supply planning. There is also deficiencies in the MoH with inadequate infrastructure and poorly trained and supervised staff. Strengthening these aspects is therefore the priority and the next Global Fund grant should contribute to improve the whole supply chain for TB medicines.
The Stop TB Partnership’s Global Drug Facility (GDF) conducted TA mission to Kenya from 26 February to 8 March, 2018. Currently, 70% of all first line TB medicines (FLDs) and TB laboratory commodities supplied to Kenya are financed by the Government of Kenya while the remaining 30% and 100% of all second line TB medicines (SLDs) and GeneXpert supplies are supported by the Global Fund. During the mission, technical assistance was provided to the country in the review of forecasting assumptions for both FLDs and SLDs based on the current TB patients’ enrollment trends.
In addition, new NTP/PSM staff and the recently revitalized commodity security group were supported to effectively apply the QuanTB tool in updating 2018/2019 quantification data based on the revised assumptions and as the early warning system (EWS) to prevent stock outs or wastage. Following the quantification review, the country agreed to revise the supply plan for 2018/2019. Additional recommendation was made to ensure TB patients’ enrolment data by regimen is well captured in the current TIBU electronic TB surveillance system, regularly analysed and used to guide future forecasting and supply plan reviews. The need to strengthen TB laboratory commodities management system was also highlighted.
The mission also reviewed progress in the introduction of new tools. Kenya started rolling out new pediatric formulations since October 2016. At the time of the mission, old pediatric formulations had been completely phased out. A nationwide rollout of the Shorter Treatment Regimen (STR) for Drug Resistant TB cases had already started since October 2017 with the current uptake being higher than previously planned. The uptake of new medicines is expected to increase as a result of adoption of rapid diagnostic test such as second line (SL) Line Probe Assay (LPA). Based on this, in addition to the current plans to integrate ADR reporting into the TIBU electronic system, the mission advised the NTP to capitalize on the existing capacity to conduct active medicines safety surveillance at Kenya Pharmacy and Poison Board (PPB) and ensure active drug safety monitoring and management (aDSM) system is immediately established.