Annual Supranational Laboratory Network Meeting

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Annual Supranational Laboratory Network Meeting

Institut Pasteur, Paris, FranceOctober 24, 2005
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Outline

• Status of the network/new SRLs
• "National Institutions," ToR, Logo, coordination
• Financial issues
• Global Project coverage
• Issues in DRS
• New DRS Guidelines
• New TB control strategy, the Global Plan and
  implications for the SRLN
• Way forward ..

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• Welcome to the network

PAHO- Mexico- Susana Balandrao Instituto Nacional
de Diagnostico y Referencia Epidemiologicos
(National Diagnostic and Epidemiologic Reference
Institute) (INDRE) in Mexico City PAHO-
Argentina- Lucia Barrera National TB Reference
Laboratory, Buenos Aires, Argentina EMRO- Egypt-
Mushira Ismail National TB Reference Laboratory,
Cairo, Egypt WPRO- Australia- Ivan Bastian and
Richard Lumb Insitute of Medical and Veterinary
Science, (IMVS), Adelaide, Australia SEARO-
Candidate under evaluation Dhanida and Somsak
Rienthong, Thailand NRL, Bureau of AIDS, TB and
STIsDepartment of Disease Control
Candidate SRLs nominated by WHO regional
offices Based on regional needs
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The Supranational Laboratory Network (SRLN) 2005
(links with gt150 countries)
Coordinating Centre
SRL
Under evaluation
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The Supranational Laboratory Network (SRLN) 2005

• Coordinating Centre Antwerp, Belgium
• Global total 25 laboratories, one candidate
• Strong regional networks developing
• 11 rounds of proficiency testing,
• 150 reference laboratories have received panels

• 4 annual network meetings
• Link/subgroup/regional networks
• Two ongoing SLD studies
• Other studies planned

Africa 2 Americas 5 Middle East 1 Europe 11
South Asia 1 and 1 candidate Western Pacific 5
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• Legal Status

WHO status "National Institutions recognized by
WHO." Process to go through regional offices and
national bodies. ToR Developed, to be
circulated November http//www.who.int/csr/disease
/influenza/en/TORNICs.pdf Logo independent logo
permitted by WHO legal department Coordination..

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Global Project finances
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• Finances

• Better coverage in protocol budget
  development, including budget for shipment
• More surveys covered by GFATM and donors,
  freeing funds for laboratory TA, offset by
  increasing survey costs weak dollar.
• More compensation expected with DOTS-Plus roll
  out
• Possibilities of financing via "research"

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Surveillance

• The routine collection of data about disease
  frequency and distribution the analysis of those
  data and the dissemination of that information
  to those who need to know.
• Information to answer three questions
• How big is the problem?
• Where and to whom should limited resources go?
• Is the problem getting better with my
  interventions?

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Global Project coverage 2005
Baseline achieved
Ongoing/Finalizing
Planned
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Types of surveillance and trend data 109 settings
1994-2002
Anti-tuberculosis Drug Resistance in the World,
Report no.3
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Progress in DR surveillance

• 13 surveys ongoing
• 33 surveys in preparation
• 18 surveys in the pipeline
• Trend/surveillance with gt3 data points from 48
  settings
• Representative retreatment data from gt10 high
  priority settings
• Second line DST 15 settings where isolates with
  FLD resistance were tested for selected SLD
  resistance
• DRS/HIV in context of routine survey/surveillance
  from 6 survey settings and undetermined number
  surveillance settings
• Data from 5 Prison settings

including HBC China, India and Russia, and
HB Africa
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Adding research questions to routine surveys

• Acquisition R in high HIV prevalence settings
• MDR/HIV
• Rapid/genetic testing
• Routine testing of SLD
• OR (misclassification, transport systems, risk
  factors)

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ISSUES in Anti-TB Drug resistance Surveillance
and Testing
Laboratory SAFETY of Culture and DST QUALITY of
Culture and DST AVAILABILITY of Culture and DST
NO standardized methods for 2nd line DST, DST
for some drugs unreliable Transport of strains
expensive, legal/ethical implications SRLN bears
much of the cost, and TA often limited to PT and
initial assessments No capacity to determine
TRUE acquired resistance New technologies must
be combined with functional and safe conventional
methods-Slow integration of new technologies-
pilots with MGIT, starting to pilot genetic
methods
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New DRS Guidelines

• Flexible surveillance approach- fitting the needs
  of countries
• Retreatment cases
• Samples for repeat surveys
• Attention to clusters
• Classification of cases
• Ethical issues
• Small surveys for DOTS-Plus regimen design
• Update of SDRTB software
• Required update for changes in 2nd testing
  approach and combined HIV surveillance

Principles -Sample accurately represents
population under study -Quality assured
laboratory results -Differentiation between
new and previously treated cases
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• WHO Stop TB Strategy

• Pursuing quality DOTS Expansion
• Addressing TB/HIV and MDR
• Contribute to health systems strengthening
• Engaging all care providers
• Empowering patients and communities
• Enabling and promoting research

STAG, WHO Regional Advisers meeting, Versailles
meeting, DOTS-Plus, DOTS Expansion, and TB/HIV
workings groups RECOGNIZE THE NEED FOR
LABORATORY DEVELOPMENT
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DST expansion- Global Plan
Example of DST expansion - Western Pacific Region