From DOTS to the Stop TB Strategy

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From DOTS to the Stop TB Strategy

• Building on Achievements for Future Planning
• Stop TB Partnership Symposium at the 37th UNION
  World Conference on TB and Lung Disease
• 31st October 2006, Paris

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The burden of TB in 2005
8.9 million new cases in 2005 80 in 22
high-burden countries
1.6 million deaths in 2005 98 of these in
developing world
MDR-TB present in 102 of 109 countries and
settings surveyed, XDR-TB emerging
219,000 deaths due to TB/HIV
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Global TB control targets
2015 50 reduction in TB prevalence and death
rates by 2015
2015 Goal 6 Combat HIV/AIDS, malaria and other
diseases Target 8 to have halted
by 2015 and begun to reverse
the incidence Indicator 23 prevalence
and deaths associated with TB Indicator 24
proportion of TB cases detected and cured
under DOTS
2005 World Health Assembly - To detect at
least 70 of infectious TB cases - To treat
successfully at least 85 of detected cases
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Over 26 million patients treated under DOTS with
high cure rates
100
Target cure 85
Target detection 70
90
80
70
60

• Case detection rate or cure rate ()

50
40
30
20
10
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
5
Estimated HIV Prevalence in TB Cases 2003
HIV prevalence in TB cases, 15-49 years ()
0 - 4
5 - 19
20 - 49
50 or more
WHO, 2005
No estimate
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MDR-TB Prevalence in New Cases 1994-2003
Tomsk(Russia)
Lithuania
Ivanovo(Russia)
13.7
12.2
9
14.2
9.3
Estonia
14.2
Kazakhstan
13.2
Latvia
Uzbekistan
14.2
10.4
Israel
Henan (China)
7.8
Liaoning(China)
5
Iran
Dominican Rep
6.6
5.3
Ivory Coast
4.9
Ecuador
WHO, DRS Report 3
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Stop TB Strategy to reach the 2015 MDGs
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In conclusion
The Strategy The Global Plan
New challenges require the new Stop TB Strategy
The new Stop TB Strategy underpins and
strengthens the Global Plan to Stop TB,
2006-2015
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Objectives of the meeting

• To review progress in scaling up TB control
  according to the Stop TB Strategy and the Global
  Plan to Stop TB, 2006-15
• To discuss major challenges and potential
  solutions to scaling up TB control according to
  the Stop TB Strategy and the Global Plan
• To determine how Working Groups can work together
  better to support country planning and
  implementation of the Stop TB Strategy.

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Achievements 1

• 84 Treatment Success rate
• 60 Case Detection rate
• Development of Country Strategic Plans 2006-2010
• Increase in DOTS coverage and DOTS infrastructure
  
• Laboratory strengthening initiatives
  (introduction or expansion of EQA)
• Strengthening planning capacity, ME and
  supervision (regular ME meetings sharing
  examples of good practice)
• Increase in available financial resources

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Achievements 2

• TB/HIV
• Policy for collaborative TB/HIV interventions and
  initiated implementation
• TB/HIV training materials developed and training
  begun
• ME Systems for TB/HIV developed
• MDR-TB
• Political commitment for MDR-TB management at
  country level and resource mobilization
• Increased funding for second-line drugs (GFATM)
• Scale up of MDR-TB treatment in many countries
  (40 countries GLC approved, more than 23,000
  patients on treatment)
• Human resources for MDR-TB
• Development of guidelines and training modules
• Training of NTP managers and consultants

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Achievements 3

• PPM
• Development of guidelines
• Scale up of successful pilots contributing to
  increase in case detection
• Training of NTPs, private sector and consultants
• ACSM
• Started to engage cured patients, affected
  communities and civil society
• Use of the media (radio messages and TV spots to
  increase TB awareness)
• GFATM grants have ACSM components

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Key Overarching Challenges

• Alignment of national plans with the Global Plan
  to Stop TB 2006-2015
• Ensuring sustainability
• Core government support
• Donor - dependent NTPs
• Donor contribution phasing out or unstable
• Political commitment with sustained and/or
  increased resources to reach MDGs and beyond
• Raising and maintaining political commitment in
  large federal systems
• Build advocacy at Global, National and
  Sub-national Levels

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Key Overarching Challenges

• Health system strengthening (quality, coverage,
  infrastructure, measurement and indicators, way
  of contributing)
• Human Resources (management, planning, quality,
  quantity, distribution, recruitment and
  retention)
• Laboratory infrastructure, staffing and capacity
• The introduction / scale up of MDR-TB, TB/HIV
  activities and those to reach special populations
  all pose highly complex challenges

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Key Overarching Challenges

• Data management and measurement of Stop TB
  component
• Maintaining and/or improving quality
• Balancing competing priorities (with other
  programmes and within TB control e.g. funding for
  some components vs basic DOTS)
• New strategy and multiple partners require better
  Coordination (internally and externally)

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Key Overarching Challenges

• Other
• Extending diagnosis to smear-negative and EP-TB,
  including HIV settings and childhood TB
• Biosafety and infection control
• Underdeveloped guidance on component 5 ACSM
• Lack of clarity around definitions of community
• Need for TA in different areas and cross-cutting
• Importance of continuity and ongoing support
• Links with HR development to ensure
  sustainability
• Translating guidelines into programmatic
  activities

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How can the working groups and partners ensure
adequate coordinated response?

• The highest priority is basic DOTS quality -
• Where DOTS has been scaled up very fast
• Where health systems, HRH and labs are very weak
• Where HIV epidemic and MDR-TB problems are the
  most severe
• Governments and partners with the least capacity
  need the most help to adopt the Strategy in full.
  
• We need to work in a new way piloting,
  assessing sharing results, while preparing and
  initiating scaling up.
• We need to continue to document results

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THANK YOU