1 Year Before

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1 Year Before
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70/85 Global Targets for 2005

• Where we were last September?
• Why we were there?
• What the STAG told us to do?
• What we have done?
• Where are we now?
• How should we proceed next 2.5 years?

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Where we were last year? 1
4
Where we were last year? 2
Global Target
Regional trend
5
Where we were last year? 2
Global Target
Regional trend
Pakistani trend
Afghanistan
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Where we were last year? 3
Other countries trend
Regional trend
Pakistani trend
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Where we were last year? 4

• Reasonable treatment success rate
• 81 treatment success rate (regional average)
• Very low case detection rate
• 26 DOTS case detection rate (reg. average)
• Difficult to achieve the global targets on time
• 35 CDR in 2005..

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Why we were there? 1

• Countries with lt30 case detection rates (2001)

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Why we were there? 2

• Countries with 30 49 case detection rates
  (2001)

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Why we were there? 3

• Countries with 50 69 case detection rates
  (2001)

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Why we were there? 4

• Countries with gt70 case detection rates (2001)

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Why we were there? 5
Notifications

• Case detection
• Notifications
• Laboratory network
• Surveillance (inc. non-nationals)
• Collaboration with other sector (private sector
  etc)
• DOTS expansion
• Estimates
• Estimates

Estimates
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What STAG told us? 1

• In Afghanistan Pakistan, largest number of
  patients do not receive DOTS care
• Wide disparity exists between case estimation and
  case notifications
• capacity of diagnostic facilities,
• reporting of cases by other sectors, part.
  private sector
• standardization of reporting by nationality
• validity of the estimates.
• Excellent start is made for operational research
• Only few countries started drug resist. surveys

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What STAG told us? 2

• STAG recommended how to
• Improve DOTS expansion in the region
• Address the disparity between estimates and
  notified cases
• Strengthen the implementation through operational
  research
• Facilitate the implementation of anti-TB drug
  resistance surveillance

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What STAG told us? 3

• STAG recommended on disparities
• Strengthening mycobacteriology laboratory
  services
• Strengthening collaboration in health sector
• Report by nationality
• Validity of estimates

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What have we done? 1

• Disparities between estimate notifications
• Laboratory services
• Laboratory network survey
• Collaboration in health sector
• Survey on health sector involvement in TB control
• Public Private Mix proposals FIDELIS
• Report by nationality
• Survey in relevant countries

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What have we done? 2

• Validity of estimates
• Field exercise (Syria) EMRO workshop
• Egypt, Iran, Jordan, Lebanon, Saudi Arabia,
  Syria, Tunisia, Yemen
• Review of epidemiological data
• Prevalence duration
• Mortality
• Annual risk of TB infection
• Proportion of detected cases

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What have we done? 3

• Validity of estimates Revised SS estimates

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What have we done? 4

• DOTS expansion in Afghanistan Pakistan

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What have we done? 5

• Operational research activities
• Workshop with IUATLD (Oct 02)
• 9 countries participated
• Small Grant Scheme 2003
• 9 TB protocols accepted
• Egypt health sector collaboration report
• Drug resistance surveillance
• Jordan, Lebanon, Syria, GCC countries

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What have we done? 6

• In-depth review
• Pakistan (April 03) Yemen (May 03)
• Global Fund
• Afghanistan, Pakistan, Egypt, south Sudan
  approved
• US 5.4M in total for 1 year
• Global TB Drug Facility
• Donation to Djibouti, Egypt, Pakistan, Somalia,
  Sudan, Yemen
• Direct procurement for Afghanistan, Iraq

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Where we are now? 1
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Where we are now? 2
DRAFT
Global targets
Current Regional trend
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Where we are now? 3
DRAFT
Global targets
Current trend
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Where we are now? 4
DRAFT
Global targets
Current trend
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Where we are now? 5
DRAFT
Global targets
Current trend
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How should we proceed? 1

• URGENT!
• 3 questions to respond during this meeting
• Are we going to achieve the global targets?
• If difficult, what are the gaps?
• How to address the gaps?
• National plans for 2004 2005
• JPRM 2004 - 2005

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How should we proceed? 2

• Progress review (group work)
• TB burden estimation
• Country exercises
• Surveillance
• Programme performance
• Laboratory network development
• Inter-sectoral collaboration
• DOTS expansion
• TB control in Iraq

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How should we proceed? 3

• Partnerships
• TB HIV / AIDS
• Operational Research
• Practical Action to Lung Health
• National plans to achieve the global targets
• JPRM 2004 2005

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We are good people 1
DOTS expansion from 1999 to 2001
1999
2001
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We are good people 2
Case detection rates from 2002 to 2005
2002
2005
Case detection rate
gt70 50-69 30-49 1-29
?