Ministerial Meeting of high M/XDR-TB burden CountriesBeijing, China, 1-3 April 2009

Mario RaviglioneDirector, Stop TB Department

Aims of the ministerial meeting

To strengthen political commitment and build engagement by governments and international community to control M/XDR-TB through better TB control and M/XDR-TB care

To use catalytically the event to (i) support countries to develop M/XDR-TB control plans and (ii) address the bottlenecks hampering progress

Main outcomes Commitment first

• Representatives from 27 + 5+ governments, donors, affected communities, and technical agencies – recognized the global M/XDR-TB emergency– committed to urgently accelerate efforts to

achieve universal access to prevention, diagnosis and treatment by 2015

– committed to develop/pursue national plans– endorsed the "Beijing call for action"

– Change and/or develop policies and identify innovative health system solutions

– Research for, and developing of, new tools– Mobilize resources, domestic and external– Engage civil society and affected communities– Engage actors in- and outside health sector– Tackle all identified bottlenecks

Main outcomes"Urgency and innovation"

Bottlenecks to scale-up M/XDR-TB prevention and management

• Major gaps in TB control, including TB/HIV care• Extremely weak M/XDR-TB management and care• Health workforce crisis• Inadequate laboratories• Quality of anti-TB drugs not assured• No restriction of anti-TB drug use• Absent infection control• Weak surveillance, monitoring & evaluation• Insufficient research• Major financial gaps

– Pursue universal health coverage as a must to remove financial barriers

– "Turn the tap off" – basic TB control is a must and links with HIV programme are essential in many settings

– Address health workforce crisis: quality and quantity– Select best models of care– Urgently develop "integrated" laboratory networks

using basic and rapid diagnostics for care & surveillance– Only use quality-assured drugs: FDCs and second-line – Restrict use of drugs to accredited care providers– Implement infection control policies everywhere– Sustain and substantially increase investments

Main outcomesPolicy decisions at the highest level

• Either you have the money or you do not• Funding gap will be alleviated by increasing the

cost-effectiveness of M/XDR-TB management through:– reduction in cost of diagnostics and quality-assured drugs

• Use GDF and GLC, apply to UNITAID and GF

– careful selection of model of care• limit hospitalization (that promotes ethics & human rights) to

medical indications• rely on ambulatory care (that promotes ethics & human rights)• build capacity for community-based M/XDR-TB care

Main outcomesFinancing and models of care

Outcomes – in detailScaling-up diagnosis

• Formulate and implement country-specific screening/diagnostic policies for rapid M/XDR diagnostics

• Prepare and cost national integrated laboratory plans• Prepare strategies for comprehensive laboratory human

resource development and retention• Work with partners to harmonise and optimise technical

and financial resources• Ensure that diagnostics are linked to timely treatment and

appropriate patient care

Outcomes – in detailModels of care

• Select sustainable models of M/XDR-TB management and care after a thorough analysis that takes into account social, ethical and health system elements which will benefit affected communities, particularly vulnerable populations, and will increase the cost-effectiveness of M/XDR-TB management

Outcomes - in detailScaling-up of M/XDR-TB

treatment and care• Ensure airborne infection control measures are

addressed in all inpatients, outpatients, laboratories and congregate settings

• Use existing or establish task forces as necessary to support an ethical based management of TB and M/XDR-TB that respects and promotes human rights

• Map the extent of HIV co-infection among M/XDR-TB patients, i.e., implement representative TB drug resistance surveillance/surveys including HIV testing

• Ensure enhanced community participation and involvement in M/XDR-TB and policy formulation on treatment and care

Outcomes - in detailGLC contribution

• Countries procuring non-GLC drugs that are meeting quality standards of stringent medicines regulatory authorities should still be eligible to access other services of the GLC initiative, such as monitoring and technical assistance.

PHS June 2009

WHA May 2009

URGENTMobilization, action, and

plans in Countries

Action ahead: beyond Beijing

Top priorities for all Countries• Awareness, recognition, commitment• Urgent MDR-TB Plan within the national TB and health plans and

using available complementary tools– Needs assessment tool (PATH)– MDR-TB planning tool (WHO)– Budgeting tool (WHO)

• Policy mechanisms and decisions immediately at NTP and MoHlevel

• Domestic and external resource mobilization strategy and tactics in an era of financial restrictions

• Rapid implementation and monitoring

Action ahead: beyond Beijing

WHO and the Stop TB Partners stand ready to support all countries

WHO DR-TB Training Modules

•Task analysis was used to develop competence-based modules•Based on material developed in Philippines by TDF and NTP•Modules train participants on MDR-TB case management•Package includes 7 participant modules, a Facilitator Guide and Reference Booklet •Generic material that can be adapted for use in country•WHO can provide technical assistance to countries to adapt the material for use in MDR-TB scale-up

Seventh Meeting of the MDR-TB Working Group of the Stop TB Partnership

Geneva, 12-14 October, 2009

All high MDR-TB burden countries will be invited to present national plans for prevention, treatment and care of M/XDR-TB, that reflect the "Beijing call for action" endorsed at this meeting, and the expected 2009 World Health Assembly resolution

Action ahead: post-Beijing

Many thanks to allTime to accelerate!

To end this scourge is a mere question of civilization (Jorge Sampaio, UN SE to Stop TB)