WHOIUATLD Global Project on AntiTB Drug Resistance Surveillance

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WHO/IUATLD Global Project on Anti-TB Drug
Resistance Surveillance

• Damascus
• September 2002

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Objectives of Anti-TB Drug Resistance Surveillance

• Estimate the magnitude of the Anti-TB drug
  resistance level and pattern
• Monitor drug resistance trends
• Evaluate the effectiveness of TB control
  Programmes
• Planning of interventions and preventive
  activities
• Evaluate interventions and preventive activities
• To inform TB treatment Policy at country level
• Strengthen Laboratory Capacity at the country
  level through yearly proficiency testing and
  training courses in DST
• Advocacy to increase Political commitment
• Identify research needs

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WHO/IUATLD Global Project
Guidelines Basic Principles

• Accurate representation of the sample studied
  and
• careful calculation of its size.

• Data collection and analysis which
  differentiates
• between new and previously treated cases.

• Internationally accepted methodology and quality
  
• control of drug testing.

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HistoryThe WHO/ IUATLD Global Project on
Antituberculosis Drug Resistance
Surveillance1994-2002
1997 The 1st Global report covered 35
countries/ geographic settings
2000 The 2nd Global report covered 58
countries/geographic settings
2003 The 3rd Global report is projecting data
from 60 countries/ geographic settings
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Current Activities

• Anti-TB Drug Resistance Surveys
• Laboratory training Moscow and Lyon
• Secretariat of Laboratory Subgroup
• Coordination of International Quality Assurance
  (QA)
• activities including shipment of strains for
  PT and QA
• Guidelines Update
• Database development

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Global Project Coverage 1994-2003
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Status of Regional Coverage
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DRS in EMR 1994 - 2003
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Global Project Summary For Third Report 2003
June 2002

Done Ongoing Planning
36 23 18
High Burden Countries
Done Ongoing Planning
4 8 2
Expected inclusions Global Report 2003
60

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DST Training

• 2 training sessions for DST in 2002
• Moscow December 5 Russian speaking Countries
  Russia (3 Oblasts), Kyrgyzstan, Moldova, Georgia
  and Uzbekistan
• Lyon, France January 2003 7 French speaking
  African Countries Burkina Fasso, Burundi, DR
  Congo, Mali, Senegal, Togo and Rwanda

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Laboratory Subgroup
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Draft Plan Of Action of the LSG

• Development of a laboratory assessment tool
• Assessment of 10 HBC
• Assisting in the implementation of improvement
  plans in 5 countries
• Assisting in the development of country-specific
  EQA for smear microscopy

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Quality Assurance Programme for Anti-TB Drug
Susceptibility Testing
SRLN Coordinating Laboratory, Antwerp, Belgium
Panel of 30 Strains yearly proficiency testing
20 SRL
Panel of 20 Strains yearly proficiency testing
QA of Survey Results
National Reference Laboratories
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WHO/IUATLD Supranational Reference Laboratories
(SRL) Network
AFRO Unit for TB Operational Research and Policy
(NTRP), Pretoria, SOUTH AFRICA Institut Pasteur
d'Algérie, Alger, ALGERIA AMRO Instituto de
Salud Public de Chile, CHILE CDC, Atlanta,
USA Massachusetts State Laboratory (MSL) Boston,
USA EURO Institut de Médecine Tropicale,
Antwerp, BELGIUM (SRL Coordinating
Laboratory) Forschungszentrium (FZB) Borstel,
GERMANY Kuratorium Tuberkulose in der Welt,
Gauting, GERMANY National Institute of Public
Health, Prague, CZECH REPUBLIC Swedish Institute
for Infectious Disease Control, (SIDC)
Stockholm,SWEDEN Instituto Nacional de Saúde,
Porto, PORTUGAL Vall d'Hebron", Barcelona,
SPAIN Istituto Superiore de Sanita, Rome,
ITALY NIHEP, Bilthoven, NETHERLANDS Institut
Pasteur, Paris, FRANCE Dulwich Public Health
Laboratory (DPHL), London, UK SEARO TB Research
Centre (TRC), Chennai, INDIA WPRO Research
Institute of Tuberculosis (RIT), Tokyo,
JAPAN Queensland Diagnostic and Reference Centre
for Mycobacterial Diseases, Brisbane,
AUSTRALIA Korean Institute of Tuberculosis,
Seoul, REPUBLIC OF KOREA
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SRL Candidate

• EMR NRL in Egypt
• AMR NRL Argentina
• NRL Mexico
• WPR Reference Laboratory Hong Kong

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Guidelines and Software

• Guidelines currently being revised. Remaining
  question What to do with MDR patients identified
  during the survey? With special consideration to
  countries where 2nd line drugs are not available.
• SDRTB4 is currently being field tested for
  release end 2002.

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Next Steps

• Continued expansion of the Global Project and
  monitoring of trends in countries with more than
  one data point.
• Development and release of the 3rd Global Report
  in
• March 2003
• Strengthen collaboration between WHO HQ,
  Regional,
• Country Offices, NTP and other Partners in
  planning,
• monitoring and implementing anti-TB drug
  resistance
• surveillance

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• Ensure that DRS is a part of the country proposal
  for the Global Fund
• Ensure that reliable data on Drug Resistance are
  available or will be available before or at time
  of implementing interventions i.e DOTS Plus
  and/or GDF
• In collaboration with the DEWG, STB, SRL Network,
  TDR and other partners, broaden the scope of
  activities of the SRL to cover all TB laboratory
  technical and managerial aspects i.e. sputum
  smear microscopy, training, biosafety as a part
  of the Laboratory Subgroup Secretariat.