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

The burden of TB in 2005

1.6 million deaths in 2005 – 98% of these in developing world

219,000 deaths due to TB/HIV

MDR-TB present in 102 of 109 countries and settings surveyed, XDR-TB emerging

8.9 million new cases in 2005 – 80% in 22 high-burden countries

Global TB control targets

2005: World Health Assembly:- To detect at least 70% of infectious TB cases- To treat successfully at least 85% of detected cases

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

Over 26 million patients treated under DOTS with high cure rates

0

10

20

30

40

50

60

70

80

90

100

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

•C

ase

det

ecti

on

rat

e o

r cu

re r

ate

(%)

Target cure 85% Target detection 70%

Estimated HIV Prevalence in TB Cases 2003Estimated HIV Prevalence in TB Cases 2003

0 - 4

5 - 19

20 - 49

50 or more

HIV prevalence in TB cases, 15-49 years (%)

No estimateWHO, 2005

MDR-TB Prevalence in New Cases: 1994-2003

WHO, DRS Report #3

9.4

Estonia

Ivanovo(Russia)

Latvia

Henan (China)

IranLiaoning(China)

Dominican Rep

5 7.810.4

99.3

12.2

Tomsk(Russia)

13.7

Israel14.2

6.6

5.3Ivory Coast4.9Ecuador

14.214.2

Kazakhstan13.2Uzbekistan

Lithuania

Stop TB Strategy to reach the 2015 MDGs

In conclusion…In conclusion…

New challenges require the new Stop TB Strategy

The new Stop TB Strategy underpins and strengthens the Global Plan to Stop TB, 2006-2015

The Strategy & The Global Plan

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.

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, M&E and supervision (regular M&E meetings; sharing examples of good practice)

Increase in available financial resources

Achievements 2

TB/HIV Policy for collaborative TB/HIV interventions and initiated

implementation TB/HIV training materials developed and training begun M&E Systems for TB/HIV developedMDR-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

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

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

• 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

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)

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

Key Overarching Challenges

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

THANK YOU…