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  • 1 Green Light Committee Initiative

    Role of theGreen Light Committee Initiative in MDR-TB Treatment Scale-up

    SALMAAN KESHAVJEE, MD, PHD

    CHAIR GREEN LIGHT COMMITTEE

    BEIJING, PEOPLES REPUBLIC OF CHINAAPRIL 3, 2009

  • 2 Green Light Committee Initiative

    PURPOSE OF THE GLCPURPOSE OF THE GLC

    Created in 2000 by the WHO and the Stop TB Partnership to ensure:

    Access to quality assured second line drugs at affordable prices

    Monitoring and evaluation of second-line drug use in approved projects

    Promotion of technical assistance for MDR-TB projects

  • 3 Green Light Committee Initiative

    Green Light Committee 2000 to 2009Green Light Committee 2000 to 2009

    Members: WHO, CDC, IUATLD, Latvian National TB Programme,

    Partners In Health/Harvard Medical School, Mdecins Sans Frontires, KNCV, Hospital F.J. Muniz Argentina, World Care Council.

    Former members include: Medical Research Council (South Africa), Estonian National TB Programme and the Peru National TB Programme.

    Role: A legal advisory body of the WHO A sub-group of the Working Group on MDR-TB in the Stop TB Partnership

    Tasks: 1. Provide policy advice on drug-resistant TB to the WHO.2. Review project applications for countries entering the GLC mechanism. 3. Promote technical assistance to countries/programs through WHO and

    its partners. 4. Provide access to reduced-priced 2nd line anti-TB drugs through GDF.5. Provide access to independent monitoring and evaluation through WHO and

    its partners.

  • 4 Green Light Committee Initiative

    GLC Initiative: 8 years (2000 to 2008)GLC Initiative: 8 years (2000 to 2008)

    0

    10000

    20000

    30000

    40000

    50000

    60000

    2000 2001 2002 2003 2004 2005 2006 2007 2008

    Pat

    ient

    s ap

    prov

    ed

    0

    20

    40

    60

    80

    100

    120

    140

    160

    App

    licat

    ions

    GLC approved (cumulative)

    Cumulative number of applications

    ~ 50'000 ~ 50'000 patients patients

    approved for approved for enrolmentenrolment

  • 5 Green Light Committee Initiative

    GLC approved projects as of December 2008GLC approved projects as of December 2008134 applications in 61 countries 134 applications in 61 countries

    ~ 50'000 patients approved for enrolment~ 50'000 patients approved for enrolment

    1. Bangladesh2. India3. Indonesia4. Myanmar5. Nepal6. Timor-Leste

    1. Burkina Faso2. Cameroon3. DR Congo4. Ethiopia5. Guinea6. Kenya 7. Lesotho8. Mozambique9. Rwanda10. Uganda11. Tanzania

    1. Belize2. Bolivia3. Costa Rica4. Dominican Republic5. Ecuador6. El Salvador 7. Guatemala8. Haiti9. Honduras10. Mexico11. Nicaragua12. Paraguay13. Peru14. Uruguay

    1. Egypt2. Jordan 3. Lebanon4. Pakistan5. Syria6. Tunisia

    1. Armenia2. Azerbaijan3. Belarus4. Bulgaria5. Estonia 6. Georgia7. Kazakhstan8. Kyrgyzstan9. Latvia 10. Lithuania11. Moldova 12. Romania13. Russia14. Serbia 15. Tajikistan16. Ukraine17. Uzbekistan

    1. Cambodia2. China3. Micronesia4. Mongolia5. Philippines6. Samoa 7. Vietnam

  • 6 Green Light Committee Initiative

    Successful collaboration with donorsSuccessful collaboration with donors

    "To help contain resistance to second-line anti-TB drugs and consistent with the policies of other international funding sources, all procurement of medications to treat MDR-TB must be conducted through the Green Light Committee (GLC)"

    Third Board Meeting, 10-11 October, 2002

    Second-line drugs for low and lower-middle income countries; thousands of patients to be enrolled in 2007-2011; creation of a Global Buffer Stock of SLDs and a Revolving Fund

    Funds for Technical Assistance and

    Monitoring/Evaluation

  • 7 Green Light Committee Initiative

    Technical DocumentsTechnical Documents

    Source: http://whqlibdoc.who.int/publications/2008/9789241547581_eng.pdf

  • 8 Green Light Committee Initiative

    Contribution to MDGsContribution to MDGs

    The GLC mechanism contributes to the following Millennium Development Goals:

    Meeting the global tuberculosis control targets and prevent development of almost incurable forms of TB (XDR-TB) (MDG 6, target 8)

    Increase access to quality-assured, affordable second-line drugs for the treatment of drug-resistant TB (DR-TB) among well-performing TB control programs in developing countries (MDG 8, target 17, WHA 60.19);

  • 9 Green Light Committee Initiative

    Green Light Committee Initiative: ComponentsGreen Light Committee Initiative: Components

    Green Light Committee

    Green Light Committee Secretariat

    (housed in the WHO)

    WHOStop TB Dept

    Global DrugFacility

    Policy advice

    Application review

    GLC administration Technical Assistance Drug Procurement

    High-level expertise on the management of MDR-TB programmes based on best available evidence and collective experience.

    Peer support and knowledge sharing in communication with other GLC-approved programmes.

    Technical assistance through a wide network of technical partners.

    Independent external monitoring and evaluation of approved programmes.

    Quality-assured second-line drugs to treat MDR-TB at concessionary prices.

  • 10 Green Light Committee Initiative

    General strategy for MDR-TB Scale-upGeneral strategy for MDR-TB Scale-up

    Development of a GLC-approved pilot project

    Expansion of the pilot project

    Integration into the national TB control strategy

    Nationwide scale-up/universal access

    GLC mechanism can provide coordinated TA at every stage of this process

    Countries Need to Drive Process

  • 11 Green Light Committee Initiative

    GDFProcurement Agent

    GLCExpert committee

    The GLC Initiative: Understanding the ProcessThe GLC Initiative: Understanding the Process

    GLC Secretariat GDF:Procurement

    Country/Project

    WHO:Technical

    Support / M&E

    2 months

    Country/Project

  • 12 Green Light Committee Initiative

    1. Need to treat all DR-TB patients as early as possible with quality assured drugs and under sound programmatic conditions in order to prevent transmission of DR-TB.

    2. MDR-TB management through the GLC strengthens basic TB control, helps to improve the quality of DOTS, and contributes to health systems strengthening

    3. Integrating MDR-TB treatment into national programs can be difficult in many settings due to the fact that it is demanding,complex and costly.

    Challenges: Implementing pilot projects Integrating DR-TB treatment within national TB control

    strategies Expanding treatment to provide universal access in rural

    and urban areas

    Lessons Learnt from Current GLC Projects & WHO DRS DataLessons Learnt from Current GLC Projects & WHO DRS Data

  • 13 Green Light Committee Initiative

    Areas of MDR-TB Management: Main ObstaclesAreas of MDR-TB Management: Main Obstacles

    Uninterrupted access to

    quality-assured second-line drugs

    DRUGS

    Appropriate and timely diagnostics

    DIAGNOSIS

    Delivery of care for two years with

    appropriate management of adverse events

    CARE DELIVERY

    Programs need help to build laboratory capacity for diagnosis of patients

    and monitoring of treatment. This includes the implementation of

    available new diagnostics (GLI and

    partners).

    Programs need help in the area of drug supply management (TB and ancillary drugs) and

    forecasting

    Global supplies of drugs and procurement

    mechanisms need to be strengthened

    Programs need help with pilot program

    implementation, DR-TB treatment integration into

    national TB control strategies, capacity building

    (HR), and scale-up

    Monitoring & Evaluation

  • 14 Green Light Committee Initiative

    Green Light Committee Initiative: Enhancing the mechanism for scale-upGreen Light Committee Initiative: Enhancing the mechanism for scale-up

    Green Light Committee

    Green Light Committee Secretariat

    (housed in the WHO)

    WHOStop TB Dept

    Global DrugFacility

    Policy advice

    Application review

    GLC administration (includes Training and coordination of GLC consultants)

    Provides technical assistance to programs (pre- and post-application) through the MDR-TB team and partners

    Drug Procurement

    GLC MDR-TB Support Unit data collection from internal and

    external sources

    data analysis

    coordinate TA (long-term; on-site) to countries (GLC and non-GLCcountries) working with TB Teamand partners

    provide assistance on drugmanagement

  • 15 Green Light Committee Initiative

    The GLC mechanism and the futureThe GLC mechanism and the future

    The GLC mechanism is working with projects and countries to facilitate scale-up of DR-TB treatment.

    The success of the mechanism depends on: Push from countries themselves for integrated DR-TB

    treatment/management

    Reliable supply of QA drugs at concessionary prices

    Newer models of technical assistance stressinglong-term, on-site approaches that build local capacity

    Sufficient funding for countries to implement programs

    Sufficient staffing and financial resources at the level of the GLC mechanism to ensure its functions WHO member countries have a direct stake in this

  • 16 Green Light Committee Initiative

    THANK YOU