WHOrecommended Stop TB Strategy

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WHO-recommended Stop TB Strategy the Global
Plan II to Stop TB 2006-2015
Intercountry Workshop on Proposal Development for
GFATM Round 6 Cairo, EGYPT, 29 May 1 June
2006 Giuliano GARGIONI STB/THD - WHO Geneva
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The global incidence of Tuberculosis continues to
rise as a result of the growing epidemic in Africa
600
AFR high HIV
500
400
300
Incidence per 100,000 per year
AFR low HIV

200
Sth East Asia
World
West. Pacific
100
East. Medit.
East. Europe
Lat. America
Cent. Euro,
0
Est Market
1990
1995
2000
2005
2010
2015
Stop TB Department
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Stop TB Department
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Effect of Global DOTS Expansion Planon the
case-detection rateOver 20 Million patients
treated with DOTS since 1995
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5 targets for global TB controlMILLENNIUM
DEVELOPMENT GOALS"to have halted and begun to
reverse incidence.."

• Implementation (DOTS) - WHA 2005
• Indicator 24 (target year 2005)
• Case detection gt70 (gt 6 m diagnosed)
• Treatment success gt85 (gt 5 m cured DOTS)
• Impact - TBP 2015
• Indicator 23 (target year 2015 cf 1990)
• Prevalence 50 of 300/100K
• Deaths 50 of 30/100K (lt 1m deaths)

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WHO-recommended Stop TB Strategy to Reach the
2015 MDGs

• Pursuing quality DOTS expansion and enhancement
• Political commitment
• Case detection through bacteriology
• Standardised treatment, with supervision and
  patient support
• Effective drug supply system
• Monitoring system and impact evaluation
• Additional components
• 2 Addressing TB/HIV and MDR-TB
• 3. Contributing to health system strengthening
• 4. Engaging all care providers
• 5. Empowering patients and communities
• 6. Enabling and promoting research (diagnosis,
  treatment, vaccine, OR)

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The Anchor of the WHO-recommended Stop TB
Strategy 1. Pursue quality DOTS Expansion
Enhancement

• Political commitment with long-term planning,
  adequate human resources, expanded sustainable
  financing to reach WHA and MDG targets
• Case detection through bacteriology (microscopy
  first, culture/DST) and strengthening of the
  laboratory network to facilitate detection of
  SS, SS-, DR- and MDR- TB cases
• Standardized treatment, under proper case
  management conditions, including D.O.T. to reduce
  the risk of acquiring drug resistance, and
  patient support to increase adherence and chance
  of cure
• An effective and regular drug supply system,
  including improvement of drug management capacity
  
• Efficient monitoring system for programme
  supervision and evaluation including measurement
  of impact

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Other 5 Components of the WHO-recommended Stop TB
Strategy

• Addressing TB-HIV, MDR-TB and other special
  challenges, by scaling up TB/HIV joint
  activities, DOTS Plus, and other relevant
  approaches
• Contributing to health system strengthening by
  collaborating with other health programmes and
  general services in, e.g., mobilizing the
  necessary human and financial resources for
  implementation and impact evaluation, and by
  sharing and applying achievements of TB control
• Engaging all care providers, public,
  non-governmental and private, by scaling up
  public-private mix (PPM) approaches to ensure
  adherence to the International Standards of TB
  Care, with a focus on the providers of the
  poorest
• Empowering patients and communities by scaling up
  community TB care and creating demand through
  context-specific advocacy, communication and
  social mobilization
• Enabling and promoting research to improve
  programme performance and for developing new
  drugs, diagnostics and vaccines

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From Stop TB strategy to MDG impact
Inputs
Process
Outputs
Impact
Planned activities 1. DOTS coverage 2. DOTS
quality package -HR strategy -Supervision
-Quality microscopy -Drug management -IEC 3.
PPM DOTS 4. Community DOTS 5. PAL 6. Culture
and DST 7. Pro-poor strategy

• Improve TB management
• Improve diagnostic quality
• Improve case management
• Improve referral routines
• Improve recording and reporting

• TB control outcomes
• Increase case detection
• Improve treatment success rate

• MDG6
• TB control impact
• Reduce TB incidence
• Halve TB prevalence
• Halve TB death rate

• Equity outcomes
• Reach all patients, especially the poor
• Decrease diagnostic delay
• Reduce patients' direct and indirect costs

MDG1 Poverty impact Halve poverty and
hunger Reduce poverty and hunger among people
with TB and their families

• Adapt services to the poor
• Involve communities
• Involve providers that serve the poor
• Provide free services
• Reduce unnecessary tests
• Decentralize DOT

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Steps in developing Global Plan II

• Define and cost activities
• 1. DOTS coverage
• 2. DOTS quality package
• 3. PPM DOTS
• 4. Community DOTS
• 5. PAL
• 6. Culture and DST
• 7. Pro-poor strategy (part of all above)
• Estimate expansion pace of activities (countries
  - regions)
• Estimate effect of scaled up activities on case
  detection and treatment success ("common sense",
  no modelling)
• Incorporate TB/HIV and DOTS plus interactions
• Estimate effect on MDG targets (modelling)

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What is the Global Plan?
- 10 year perspective on the road to 2050
- Response to country needs for long term planning
- Outlines financial requirements for
sustainability

• A pathway towards the Partnership's targets for
  2015 and 2050 goal

- A Plan with credibility will serve a key
advocacy role
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Structure of the Global Plan
- Part I General strategic directions
- Part II Regional scenarios
- Part III Specific actions / plans
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Part I General Strategic Directions
- Stop TB Strategy

• Development and deployment of new tools
  (diagnostics, drugs and vaccines)

• Cross-cutting issues
• (health systems, poverty, children, gender)

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Part II Regional Scenarios
Impact and costs of implementation of activities

• DOTS

• DOTS-plus

• TB/HIV

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Part III Strategic Plans
Seven Working Groups
DOTS expansion
New Drugs
New Diagnostics
DOTS plus
TB/HIV
New Vaccines
Advocacy, Communications Social Mobilization
and the Partnership Secretariat
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Projected Rates of TB Prevalence

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Projected Rates of TB Deaths

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In summary

- Achieve the Millennium Development Goal to have
halted and begun to reverse the incidence of TB
by 2015
- Save an additional 14 million lives
- Treat 50 million people for TB
- Put 3 million TB patients co-infected with HIV
on ARVs
- Treat 800,000 people for MDR-TB
- Expand access to high-quality TB diagnosis and
treatment for all
- Produce the first new anti-TB drug in 40 years
by 2010
- Develop a new vaccine by 2015
- Provide rapid and inexpensive diagnostic tests
at the point of care
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Eastern Mediterranean Region Planned scale-up of
activities

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Eastern Mediterranean Region Estimated impact of
intensified activities - 1
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Eastern Mediterranean Region Estimated impact of
intensified activities - 2
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Eastern Mediterranean Region Estimated impact of
intensified activities - 3
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Eastern Mediterranean Region Estimated impact of
intensified activities - 4
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Eastern Mediterranean Region Estimated impact of
intensified activities - 5
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Eastern Mediterranean Region Estimated cost of
intensified activities
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Total Needs Available funding Funding Gap,
2006-2015

Total needs 56 billion
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Total Country Needs for Implementation by
region 2006-2015

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Total Needs by Area of Responsibility 2006-2015

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Total Needs for Countries, RD, International
Agencies 2006-2015