TB ProgrammeChecklist

We are calling upon all governments to #StepUpforTB and ensure their TB policies and practices are in line with the recommendations below

Tuberculosis (TB), the world’s deadliest infectious disease, killed 1.7 million people in 2016.

The 29 countries surveyed in the Out of Step report need to update their practices to ensure that TB is effectively diagnosed and treated in line with the latest international guidelines. But how exactly can this be achieved?

The Out of Step report identified:

5 key areas in which the 29 countries surveyed are failing to follow best practices for TB diagnosis and treatment.

15 recommendations that governments can follow to bring their TB practices in line with WHO guidelines in these 5 key areas.

Recommendations for best polices, practices and guidelines

RAPID DIAGNOSIS

Everyone deserves access to rapid and accurate molecular diagnostic tests

DIAGNOSTIC CHECKLIST:

- Nobody has to pay for a TB test out of pocket.
- WHO-recommended tests (i.e. Xpert) are used as the initial diagnostic tool for all adults and children with suspected TB.
- Everyone has access to second-line drug-susceptibility testing to identify cases of drug resistant TB early.

TREATING TB PROPERLY

Governments should step in the right direction by providing patient-friendly treatment close to where people live and not requiring unnecessary hospitalisation or painful injections

MODELS OF CARE CHECKLIST:

- Drug-susceptible TB treatment can be initiated at the primary care level, and drug-resistant TB treatment can be initiated at the district care level.
- Compulsory hospitalisation is not required.
- Anti-retroviral therapy is immediately available for all people diagnosed with HIV.

PROVIDING THE RIGHT DRUGS TO PEOPLE

Governments should make sure people get the proper medication for their form of TB and ending the substandard practice of selling TB drugs over-the-counter without a prescription

DRUG REGULATION CHECKLIST:

- National TB programmes use quality-assured drugs.
- Patients need a prescription to access TB drugs.
- Governments allow accelerated registration on TB drugs to ensure life-saving treatments are available to patients as quickly as possible.

SPEEDING UP ACCESS TO NEW TB DRUGS

Governments should expedite registration and access to new and improved TB treatments that can help cure resistant forms of the disease. The first new TB drugs to come along for nearly 50 years, bedaquiline and delamanid, are not reaching people with drug-resistant forms of TB.

DR-TB TREATMENT CHECKLIST:

- Treatment practices are in line with WHO guidance.
- TB drugs recommended by WHO for treatment of drug-resistant TB are on the national Essential Medicines List.
- New drugs are made available via import waivers until they are fully registered in the country.

TREATING DRUG-SENSITIVE TB AND PREVENTING INFECTIONS

Governments can step ahead of the epidemic by treating drug-sensitive TB more effectively, implementing infection control measures and ensuring appropriate management of latent TB infections

DS-TB TREATMENT CHECKLIST:

- Daily fixed-dose drug combinations are the standard treatment regimen.
- Treatment practices, including for children, are in line with WHO guidance.
- People in regular contact with TB patients are screened for TB, and any children or people living with HIV receive preventative therapy.

Tribute:
Stephen Lawn

The Lawn Imperative: In recognition of the deadly interplay between HIV and tuberculosis (TB), all people living with HIV should be offered antiretroviral therapy as early in their disease progression as possible in order to prevent the development of TB disease.

On behalf of the TB community, Stop TB Partnership, and Médecins Sans Frontières (MSF) we acknowledge and pay tribute to the work of Professor Stephen Lawn, a devoted researcher and committed advocate for people with HIV and TB and who passed away on September 23, 2016.

Stephen Lawn Memorial Fund

KEY FINDINGS FROM THE OUT OF STEP REPORT (2017)

52%

of countries surveyed have guidelines recommending the use of Xpert MTB/RIF as the initial diagnostic test for all adults and children being investigated for TB.

50%

of countries surveyed have adopted new paediatric TB fixed dose combinations (FDCs).

66%

of countries surveyed have guidelines recommending the initiation of drug-resistant treatment at the district level.

28%

of countries surveyed have either bedaquiline or delamanid listed on their national Essential Medicines List (EML).

75%

of countries surveyed have a process of accelerated registration of DR-TB medicines, including new and repurposed TB medicines.