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Washington, D.C., Center for Global Development, 2015. 68 p.Founded in 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) is one of the world’s largest multilateral health funders, disbursing $3-$4 billion a year across 100-plus countries. Many of these countries rely on Global Fund monies to finance their respective disease responses -- and for their citizens, the efficient and effective use of Global Fund monies can be the difference between life and death. Many researchers and policymakers have hypothesized that models tying grant payments to achieved and verified results -- referred to in this report as next generation financing models -- offer an opportunity for the Global Fund to push forward its strategic interests and accelerate the impact of its investments. Free from year-to-year disbursement pressure (like government agencies) and rigid allocation policies (like the World Bank’s International Development Association), the Global Fund is also uniquely equipped to push forward innovative financing models. But despite interest, the how of new grant designs remains a challenge. Realizing their potential requires technical know-how and careful, strategic decisionmaking that responds to specific country and epidemiological contexts -- all with little evidence or experience to guide the way. This report thus addresses the how of next generation financing models -- that is, the concrete steps needed to change the basis of payment from expenses to something else: outputs, outcomes, or impact. (Excerpts)
Washington, D.C., Center for Global Development, 2016 Feb. 38 p. (Center for Global Development Working Paper 425)This paper uses contract theory to suggest simple contract designs that could be used by the Global Fund. Using a basic model of procurement, we lay out five alternative options and consider when each is likely to be most appropriate. The rest of the paper then discusses how one can build a real-world contract from these theoretical foundations, and how these contracts should be adapted to different contexts when the basic assumptions do not hold. Finally, we provide a synthesis of these various results with the aim of guiding policy makers as to when and how ‘results-based’ incentive contracts can be used in practice.
[The results of implementation of the International Bank for Reconstruction and Development Loan Project "Prevention, diagnosis, and treatment of tuberculosis and AIDS", a "tuberculosis" component]
Tuberkulez I Bolezni Legkikh. 2010; (3):10-7.Due to the implementation of the International Bank for Reconstruction and Development (IBRD) loan project "Prevention, diagnosis, treatment of tuberculosis and AIDS", a "Tuberculosis" component that is an addition to the national tuberculosis control program in 15 subjects of the Russian Federation, followed up by the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences, the 2005-2008 measures stipulated by the Project have caused substantial changes in the organization of tuberculosis control: implementation of Orders Nos. 109, 50, and 690 and supervision of their implementation; modernization of the laboratories of the general medical network and antituberbulosis service (404 kits have been delivered for clinical diagnostic laboratories and 12 for bacteriological laboratories, including BACTEC 960 that has been provided in 6 areas); 91 training seminars have been held at the federal and regional levels; 1492 medical workers have been trained in the detection, diagnosis, and treatment of patients with tuberculosis; 8 manuals and guidelines have been prepared and sent to all areas. In the period 2005-2008, the tuberculosis morbidity and mortality rates in the followed-up areas reduced by 1.2 and 18.6%, respectively. The analysis of patient cohorts in 2007 and 2005 revealed that the therapeutic efficiency evaluated from sputum smear microscopy increased by 16.3%; there were reductions in the proportion of patients having ineffective chemotherapy (from 16.1 to 11.1%), patients who died from tuberculosis (from 11.6 to 9.9%), and those who interrupted therapy ahead of time (from 11.8 to 7.8%). Implementation of the IBR project has contributed to the improvement of the national strategy and the enhancement of the efficiency of tuberculosis control.
[International financial cooperation in the fight against AIDS in Latin America and the Caribbean] La cooperacion financiera internacional para la lucha contra el SIDA en America Latina y el Caribe.
Cadernos De Saude Publica. 2014 Jul; 30(7):1571-6.This study analyzed the financial contribution by the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria and its relationship to eligibility criteria for funding in Latin America and the Caribbean in 2002-2010. Descriptive analysis (linear regression) was conducted for the Global Fund financial contributions according to eligibility criteria (income level, burden of disease, governmental co-investment). Financial contributions totaled US$ 705 million. Lower-income countries received higher shares; there was no relationship between Global Fund contributions and burden of disease. The Global Fund's international financing complements governmental expenditure, with equity policies for financial allocation.
Engaging informal providers in TB control: what is the potential in the implementation of the WHO stop TB strategy? a discussion paper.
World Health and Population. 2011; 12(4):5-13.The World Health Organization (WHO) Stop TB Strategy calls for involvement of all healthcare providers in tuberculosis (TB) control. There is evidence that many people with TB seek care from informal providers before or after diagnosis, but very little has been done to engage these informal providers. Their involvement is often discussed with regard to DOTS (directly observed treatment - short course), rather than to the implementation of the comprehensive Stop TB Strategy. This paper discusses the potential contribution of informal providers to all components of the WHO Stop TB Strategy, including DOTS, programmatic management of multi-drug-resistant TB (MDR-TB), TB/HIV collaborative activities, health systems strengthening, engaging people with TB and their communities, and enabling research. The conclusion is that with increased stewardship by the national TB program (NTP), informal providers might contribute to implementation of the Stop TB Strategy. NTPs need practical guidelines to set up and scale up initiatives, including tools to assess the implications of these initiatives on complex dimensions like health systems strengthening.
Fighting the tuberculosis epidemic in the Western Pacific region: current situation and challenges ahead.
Kekkaku. 2010 Jan; 85(1):9-16.INTRODUCTION: Tuberculosis (TB) remains a major public health problem in the Western Pacific Region. More than 20% of the global burden of TB is found in the Region. In 2007, the latest year for which data is available, there were an estimated 1.9 million incident cases (109 per 100,000 population). Four countries (Cambodia, China, the Philippines and Vietnam) account for 93% of the total estimated incident cases in the Region. Every year an estimated 300 thousand persons die due to TB. The Region is host to an estimated 135,000 multi-drug resistant TB cases, most of which can be found in China. TB PREVALENCE AND TB MORTALITY: The Regional Stop TB strategy aims to halve the prevalence and mortality rates of 2000 by 2010. Based on current estimates, the TB prevalence declined with 24% between 2000 and 2007, while TB mortality declined with 19% in the same period. Given the current annual decrease in TB prevalence and mortality, it is unlikely that the Region will achieve the 50% reduction by 2010. CASE FINDING: Approximately 1.4 million new TB cases were notified in the Region in 2007, of which close to 0.7 million smear-positive cases. Cases from China accounted for 70% of the total notified smear-positive cases. The Regional case detection rate was sustained at 78%. Case detection rates in China, the Lao People's Democratic Republic, Mongolia, the Philippines and Vietnam exceeded the 70% target. TREATMENT OUTCOMES: A total of 92% of the 0.7 million new pulmonary smear-positive cases registered for treatment in 2006 were successfully treated. The treatment success rates exceed the 85% target in all countries with a high burden of TB, except Papua New Guinea where it was reported at 73%. MULTIDRUG-RESISTANT TB: In 2007, the proportion of MDR-TB in new TB cases was estimated to be 4%. A total of 135,411 MDR-TB cases was estimated to have occurred in 2007. Based on the overall case management data, 10,231 new patients and 1,596 re-treatment patients were reported with available drug susceptibility testing (DST) results in the Region. Of these, 1% (89/10,231) and 29% (468/1,596) had MDR-TB, respectively. Capacity to detect and treat MDR-TB cases is still very limited in most countries in the Region. Eighteen countries and areas in the Region have conducted drug resistance surveillance (DRS) since 2000, according to the Global Project on Anti-tuberculosis Drug Resistance Surveillance. Among new TB cases, the prevalence of multidrug-resistant TB (MDR-TB) ranged from 0% in Cambodia to 11.1% in the Commonwealth of the Northern Mariana Islands. MDR-TB prevalence among re-treatment cases ranged from 3.1% in Cambodia to 27.5% in Mongolia. In the five countries with a high burden of TB with available data from surveys (Cambodia, China, Mongolia, the Philippines, and Vietnam), MDR-TB prevalence in new cases and re-treatment cases ranged from 0% in Cambodia to 4.9% in China and from 3.1% in Cambodia to 27.5% in Mongolia, respectively. Notably, there were alarming rates of MDR-TB in several provinces in China among both new and retreatment cases. Increasing numbers of MDR-TB cases are reported from Papua New Guinea. TB-HIV CO-INFECTION: The overall estimated prevalence of HIV in new TB cases in 2007 was 2.7%. With 8.0% in 2008 compared to 11.8% in 2003, Cambodia shows a declining prevalence of HIV in new TB cases. There was a significant increase in the use of anti-retroviral therapy (ART) in the Region. However, detailed and complete data as well as strong collaboration in HIV and TB management are needed to be able to closely monitor the use of ART and its impact on TB-HIV co-infection in the Region. CONCLUSION: In spite of the substantial progress made in most countries with a high burden of TB, substantial challenges remain in the Region. The rate of decline in TB prevalence and mortality is too low to reach the 50% reduction goal in 2010. It will be necessary to further increase TB case detection and address the emerging spread of drug-resistant TB. The slow response in the most affected countries in the Region is a cause for concern. Strong commitment by national governments and their partners is needed to sustain and further strengthen the current TB control efforts.
Bulletin of the World Health Organization. 2008 Jul; 86(7):568–576.The objective of this study was to estimate the financial resources required to achieve the 2015 targets for global tuberculosis (TB) control, which have been set within the framework of the Millennium Development Goals (MDGs). The Global Plan to Stop TB, 2006-2015 was developed by the Stop TB Partnership. It sets out what needs to be done to achieve the 2015 targets for global TB control, based on WHO's Stop TB Strategy. Plan costs were estimated using spreadsheet models that included epidemiological, demographic, planning and unit cost data. A total of US$ 56 billion is required during the period 2006-2015 (93% for TB-endemic countries, 7% for international technical agencies), increasing from US$ 3.5 billion in 2006 to US$ 6.7 billion in 2015. The single biggest cost (US$ 3 billion per year) is for the treatment of drug-susceptible cases in DOTS programmes. Other major costs are treatment of patients with multi- and extensively drug-resistant TB (MDR-TB and XDR-TB), collaborative TB/HIV activities, and advocacy, communication and social mobilization. Low-income countries account for 41% of total funding needs and 65% of funding needs for TB/HIV. Middle-income countries account for 72% of the funding needed for treatment of MDR-TB and XDR-TB. African countries require the largest increases in funding. Achieving the 2015 global targets set for TB control requires a major increase in funding. To support resource mobilization, comprehensive and costed national plans that are in line with the Global Plan to Stop TB are needed, backed up by robust assessments of the funding that can be raised in each country from domestic sources and the balance that is needed from donors. (author's)
[Washington, D.C.], United States Library of Congress, Congressional Research Service, 2007 Oct 26. 18 p. (CRS Report for Congress Order Code RL34246; USAID Development Experience Clearinghouse Doc. ID / Order No. PC-AAB-678)In 2005, TB prevalence rose only in sub-Saharan Africa and eastern Europe. WHO attributes a number of factors to this increase, including weak health systems, low-quality health care, minimal access to health facilities, insufficient staffing and little human resource development, ill-equipped and substandard laboratories, and limited coordination of TB and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) programs. In FY2008, Congress voted to fund U.S. global TB operations at unprecedented levels. The House FY2008 Foreign Operations Appropriations (H.R. 2764) provided $313.5 million for international TB programs and $300 million for a U.S. contribution to the Global Fund to Fight HIV/AIDS, TB, and Malaria (Global Fund). The Senate version of H.R. 2764 included $200 million for U.S. global TB efforts and $340 million for a U.S. contribution to the Global Fund. Both houses included $300 million in FY2008 Labor, HHS, and Education Appropriations (H.R. 3043 and S. 1710) for a U.S. contribution to the Global Fund. S. Rept.110-107 of S. 1710 also suggested that $10 million more than CDC's FY2007 operating plan for TB be provided to improve CDC's efforts to prevent TB and its progression into XDR-TB. No appropriations bills that include funds for TB efforts have been enacted. (excerpt)
Journal of the Indian Medical Association. 2007 Apr; 105(4):198, 212.Tuberculosis has been declared to be a global emergency and the HIV/AIDS is fuelling the epidemic. To contain the disease for its re-emergence a massive funding was earmarked. Widespread implementation of the DOTS strategy specially in countries of high TB burden is a major progress in global TB control. As a sizeable section of TB patients contact a private health provider, so the policy makers of health envisaged the idea for Public-Private Partnership mix model to contain the disease and hence the role of IMA with its two lacs members has definite role to play to stop the menace. The Stop TB strategy is designed to achieve the targets set for the period 2006-2015. Members of IMA have got a life time chance to prove to the people and to the power that they are not lagging behind in providing a service to the nation and there lies the strength of the IMA. (author's)
Lancet. 2007 Jul 28; 370(9584):311.In 1983, Michel Kazatchkine was a clinical immunologist at the Hôpital Broussais in Paris, France, when he was called to see a French couple with unexplained fever and severe immune deficiency who had been airlifted home from Africa. This man and woman were the first of many AIDS patients that Kazatchkine would take care of in the coming decades. There were no effective antiretroviral treatments available, and the couple lived only a few months on the ward before dying. "Those were difficult years with patients dying every day on the wards", Kazatchkine recalls. Much of his time, he says, was spent providing end-of-life care, consoling patients, "and holding their hands when they were dying". This year, after more than two decades of working in AIDS clinical care, research, and international programmes, Kazatchkine takes over the helm of the second largest funder of AIDS care: the Global Fund to Fight AIDS, Tuberculosis & Malaria. Anthony Fauci, Director of the US National Institute of Allergy andInfectious Disease, who says he has worked "up close and personal" with Kazatchkine since the early days of the epidemic, calls him "the perfect kind of person for the position". He's a scientist who understands the science; a clinician who understands clinical care; and an expert in AIDS who understands the epidemic, Fauci says. "He's also a fine 'people person': the kind of person who can build consensus, but also the kind of person who can take the lead." (excerpt)
Lancet. 2007 Jul 28; 370(9584):307-308.This spring the Global Fund to Fight AIDS, Tuberculosis and Malaria announced that its programmes had treated nearly 3 million tuberculosis patients, distributed more than 30 million insecticide-treated bednets, and were providing antiretroviral drugs to more than 1 million people infected with HIV. After nearly 5 years of operation "Global Fund programmes are saving 3000 lives a day", says the Fund's new executive director Michel Kazatchkine. The Fund was launched in 2002 to raise, manage, and disburse funds to fight three leading killers of people in poor countries: HIV/AIDS, tuberculosis, and malaria. At the time, efforts to combat those diseases were fragmented and woefully underfunded. The Fund's narrow focus has won it the approval of foreign-aid sceptics such as William Easterly, professor of economics at New York University in New York City and author of the book White Man's Burden, which critiques many current development programmes. "One of the curses of foreign aid is that each agency tries to do everything; and when you try to do everything, you tend to do a mediocre or bad job", Easterly says. (excerpt)
Journal of Infectious Diseases. 2007 Aug 15; 196 Suppl 1:S5-S14.Tuberculosis (TB) and human immunodeficiency virus (HIV) infection make each other's control significantly more difficult. Coordination in addressing this "cursed duet" is insufficient at both global and national levels. However, global policy for TB/HIV coordination has been set, and there is consensus around this policy from both the TB and HIV control communities. The policy aims to provide all necessary care for the prevention and management of HIV-associated TB, but its implementation is hindered by real technical difficulties and shortages of resources. All major global-level institutions involved in HIV care and prevention must include TB control as part of their corporate policy. Country-level decision makers need to work together to expand both TB and HIV services, and civil society and community representatives need to hold those responsible accountable for their delivery. The TB and HIV communities should join forces to address the health-sector weaknesses that confront them both. (author's)
Journal of Infectious Diseases. 2007 Aug; 196 Suppl 1:S4-.This supplement to the Journal of Infectious Diseases on tuberculosis (TB)/HIV coinfection came together as a result of a collaboration between the National Institutes of Health (NIH)-funded Centers for AIDS Research (CFARs) at Harvard University and at the University of Pennsylvania, and the Forum for Collaborative HIV Research. It is based on 2 programs addressing TB/HIV coinfection research challenges. A steering committee, consisting of Bruce Walker, Edward Nardell, Megan Murray, and Eric Rubin (Harvard University); Gerald Friedland (Yale University); and James Hoxie (University of Pennsylvania); with the support of the national network of CFARs, organized a symposium entitled "Confronting TB/HIV Co-infection" that was held on 30 June 2005 at Harvard University. The Forum for Collaborative HIV Research, together with the International AIDS Society and the Agence National de Recherches sur le Sida et les Hepatites Virales, with special support from Tibotec, sponsored a special session entitled "HIV/TB: New Visions, New Directions" during the 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment in Rio de Janeiro on 25 July 2005, followed by a roundtable discussion with representatives from the World Health Organization HIV/ AIDS and Stop TB departments; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the NIH; the Centers for Disease Control and Prevention (CDC); and leaders from the pharmaceutical industry, research networks, and advocacy organizations. (excerpt)
A research agenda for childhood tuberculosis. Improving the management of childhood tuberculosis within national tuberculosis programmes: research priorities based on a literature review.
Geneva, Switzerland, World Health Organization [WHO], 2007.  p. (WHO/HTM/TB/2007.381; WHO/FCH/CAH/07.02)Childhood TB is a neglected aspect of the TB epidemic, despite constituting 20% or more of the TB case-load in many countries with high TB incidence. This "orphan disease" exists in the shadow of adult TB and is a significant child health problem, but is neglected because it is usually smear-negative and is thus considered to make a relatively minor contribution to the spread of TB. In order to redress this neglect and integrate childhood TB into the mainstream of TB control activities, research priorities are identified that will assist in improving the prevention and management of childhood TB as a part of national TB programmes (NTPs). The proposed research agenda seeks to better define childhood TB, to optimize the treatment of childhood TB and to identify the best management practices by which childhood TB can be accurately documented and recorded, and efficiently managed within NTPs. (excerpt)
Public-private mix for TB care and control. Focus on Africa. Report of the fourth meeting of the Subgroup on Public-Private Mix for TB Care and Control, 12-14 September 2006, Nairobi, Kenya.
Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2007. 27 p. (WHO/HTM/TB/2007.378)The Subgroup on Public-Private Mix for DOTS Expansion (PPM Subgroup) was established by the global Stop TB Partnership's DOTS Expansion Working Group (DEWG) to help promote and facilitate active engagement of all relevant public and private health care providers in TB control. The members of the Subgroup include representatives from the private sector, academia, country TB programme managers, policy-makers, field experts working on the issue, international technical partners and donor agencies. At the first meeting of the Subgroup in November 2002, generic regional and national Public-Private Mix (PPM) strategies were developed and endorsed. The Subgroup's second meeting, which was held at the WHO Regional Office for South-East Asia in New Delhi in February 2004, reviewed the growing evidence base emerging from numerous PPM initiatives. This meeting also broadened the scope of PPM to include the involvement of public sector providers not yet linked to national tuberculosis programmes (NTPs). Consequently, PPM has since stood for the engagement of all public and private health care providers through public-private, public-public and private-private collaboration in TB control. The third meeting of the Subgroup, held in Manila in April 2005, identified barriers and enablers for scaling up and sustaining PPM, and discussed how to mainstream PPM into regular TB control planning and implementation. The Subgroup's current fourth meeting in Nairobi, Kenya, in September 2006 had PPM for TB control in Africa as the main focus. The problems related to the HIV epidemic, human resources for health and health sector reforms pose special challenges to countries in Africa. The meeting examined how successful PPM approaches within Africa could be scaled up and how approaches applied in other regions could be adapted to African settings. Based on a global overview, the African experience in diverse country settings and field visits to examine working PPM models and after a great deal of deliberations and discussions, the Subgroup made recommendations which are presented in Section 6 of the report. A large part of the funding for the meeting was provided by USAID's Tuberculosis Control Assistance Program (TB CAP). (excerpt)
Integration between sexual and reproductive health and HIV and AIDS and malaria: opportunities and strategic options for the Global Fund to Fight AIDS, Tuberculosis and Malaria. Discussion piece.
[London, England], HLSP, 2006 Nov.  p.There is a growing body of knowledge which emphasises integration of sexual and reproductive health (SRH) as critical to the effectiveness of responses to HIV and AIDS, and the success of HIV and AIDS programmes. Further, accelerated headway in malaria prevention and/or treatment can be achieved through integration with SRH efforts. This paper briefly explores the evidence base for integration, identifies the enabling environment at global and national levels and discusses the opportunities and challenges for supporting integration by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund). The paper concludes with strategic options for the Global Fund. (excerpt)
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.Control of tuberculosis (TB), like health care in general, costs money. To sustain TB control at current levels, and to make further progress so that global targets can be achieved, information about funding needs, sources of funding, funding gaps and expenditures is important at global, regional, national and sub-national levels. Such data can be used for resource mobilization efforts; to document how funding requirements and gaps are changing over time; to assess whether increases in funding can be translated into increased expenditures and whether increases in expenditure are producing improvements in programme performance; and to identify which countries or regions have the greatest needs and funding gaps. In this paper, we discuss a global system for financial monitoring of TB control that was established in WHO in 2002. By early 2007, this system had accounted for actual or planned expenditures of more than US$ 7 billion and was systematically reporting financial data for countries that carry more than 90% of the global burden of TB. We illustrate the value of this system by presenting major findings that have been produced for the period 2002-2007, including results that are relevant to the achievement of global targets for TB control set for 2005 and 2015. We also analyse the strengths and limitations of the system and its relevance to other health-care programmes. (author's)
Washington, D.C., United States Department of State, Office of the United States Global AIDS Coordinator, 2005 Jun. 184 p. (USAID Development Experience Clearinghouse DocID / Order No. PC-AAB-508)This June FY 2005 Operational Plan serves as an update of the February 2005 Operational Plan. The FY 2005 Operational Plan follows "The President's Emergency Plan for AIDS Relief -- U.S. Five-Year Global HIV/AIDS Strategy" and sets out a course to have an immediate impact on people and strengthen the capacity of governments and NGOs to expand programs quickly over the next several years. By the end of FY 2005 the Emergency Plan will provide direct and indirect care and support for approximately 3,500,000 individuals, and will facilitate access to antiretroviral therapy for at least 550,000 individuals. Section III of this document provides information on each country's contribution to the total number of individuals to be receiving care and support and antiretroviral therapy by the end of FY 2005. The country-specific target tables also provide the FY 2008 care and treatment targets for each country. The FY 2008 targets were set at the beginning of the Emergency Plan. The sum of all countries' FY 2008 care/support targets equals the Emergency Plan's goal of ten million individuals receiving care and support by the end of year five. The sum of all countries' FY 2008 treatment targets equals the Emergency Plan's goal of two million people on treatment at the end of year five. (excerpt)
Lancet. 2007 Mar 24; 369(9566):965.Tuberculosis continues to kill nearly 2 million people every year, most of whom are in the lowest income countries. Since the launch of WHO's new Stop TB Strategy a year ago in this journal, three major threats to tuberculosis control can be identified: the spread of all forms of drug resistance, including extensively drug-resistant tuberculosis (XDR-TB); the challenges of successfully diagnosing and treating HIV-infected patients with tuberculosis; and the failure to attract sufficient funding to put all necessary control measures into place. These threats indicate that global tuberculosis control targets will not be met. The inexorable rise of drug-resistant strains (one in ten new infections is resistant to at least one antituberculosis drug), and the worrying spread of XDR-TB, threaten to undermine tuberculosis control efforts. 35 countries, including all those in the G8, have now confirmed XDRTB cases. But it is in South Africa that XDR-TB poses the greatest threat because of its particularlyhigh mortality in HIV-positive people--most patients will die before the diagnosis of XDR-TB can be confirmed. There are now 269 confirmed XDR-TB cases in South Africa, where it has spread from its place of first discovery last year, the province of KwaZulu Natal, to all parts of the country. There is a real danger that HIV infection will fast track the spread of XDR-TB into a global epidemic. According to Mario Raviglione, director of Stop TB at WHO, an appeal for US$95 million made last October to counter XDR-TB generated little response; WHO now estimates that $650 million is needed for multidrug-resistant tuberculosis and XDR-TB control in 2007 alone. (excerpt)
WHO training course for TB consultants: RPM Plus drug management sessions in Sondalo, Italy, September 28 - October 1, 2006: trip report.
Arlington, Virginia, Management Sciences for Health, Center for Pharmaceutical Management, Rational Pharmaceutical Management Plus, 2006 Oct 18. 26 p. (USAID Cooperative Agreement No. HRN-A-00-00-00016-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ACI-323)WHO, Stop-TB Partners, and NGOs that support country programs for DOTS implementation and expansion require capable consultants in assessing the capacity of countries to manage TB pharmaceuticals in their programs, developing interventions, and providing direct technical assistance to improve availability and accessibility of quality TB medicines. Beginning in 2001, RPM Plus, in addition to its own formal courses on pharmaceutical management for tuberculosis, has contributed modules and facilitated sessions on specific aspects of pharmaceutical management to the WHO Courses for TB Consultants in Sondalo. The WHO TB Course for TB Consultants was developed and initiated in 2001 by the WHO Collaborating Centre for Tuberculosis and Lung Diseases, the S. Maugeri Foundation, the Morelli Hospital, and TB CTA. The main goal of the course is to increase the pool of international level TB consultants. As of December 2005, over 150 international TB consultants have participated in the training, a majority ofwhom have already been employed in consultancy activities by the WHO and international donors. In 2006 fiscal year RPM Plus received funds from USAID to continue supporting the Sondalo Course, which allowed RPM Plus to facilitate sessions on pharmaceutical management for TB at four courses in May, June, July, and October of 2006. RPM Plus Senior Program Associate, Edgar Barillas, traveled to Sondalo from September 28 to October 1 to facilitate the TB pharmaceutical management session at the WHO course for TB Consultants in Sondalo, Italy. (excerpt)
Lancet. 2007 Feb 24; 369(9562):626-627.In today's Lancet, Longde Wang and colleagues report on many remarkable recent improvements in the control of tuberculosis in China. The progress is good news in view of the size and global importance of the tuberculosis burden in China and the faltering of control in the 1990s, as noted by Wang. The fruitful partnership with WHO, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and several governments and non-governmental organisations is also noteworthy, as is the commitment to transparent reporting and health-system reform in China today in the environment after the outbreak of severe acute respiratory syndrome. Better control of tuberculosis in China is also timely in view of the high rates of multidrug resistance, and the emergence of HIV infection in some population subgroups also at high risk of tuberculosis. One group of special concern are work migrants, most often poor young men, who leave the countryside to join the wage economy in towns and cities all over China. Some come from areas such as Henan Province where huge numbers of peasants were infected with HIV from scandalous plasma--donor practices in the 1990s. Many male migrants are at risk of unprotected sex when away from home. And men are also at higher risk of tuberculosis than women in China because the male-to-female ratio of adults with pulmonary tuberculosis is about 2:1 or more, reflecting a real risk excess rather than differential detection or notification. So several factors converge in young male migrant workers to put them at risk of both HIV and tuberculosis, and this convergence must be of great concern. (excerpt)
Geneva, Switzerland, WHO, 2006.  p. (WHO/HTM/STB/2006.36)During 2005, the Stop TB Partnership continued to work towards the goal of eliminating tuberculosis (TB) as a public health problem and obtaining a world free of TB. Through a dynamic network of international organizations, national governments, donors and nongovernmental organizations that share this goal, the Partnership strengthened its reputation as an effective force in global TB control. The major achievement of the Stop TB Partnership in 2005 was the development of the Global Plan to Stop TB, 2006--2015, a blueprint for TB control over the coming decade. This landmark achievement was the result of intense work by the Partnership's Working Groups and all of its partners, and is underpinned by the new Stop TB Strategy of WHO. The Global Plan and the new Stop TB Strategy were both endorsed by the Coordinating Board (CB) of the Partnership. The CB met twice in 2005, first in Addis Ababa (Ethiopia) and then in Assisi (Italy), and took major decisions on governance, business processes and technical issues. The CB delegations undertook a number of important advocacy missions on behalf of the Stop TB Partnership including Gaborone (Botswana), Ottawa (Canada), Jakarta (Indonesia), Rome (Italy) and Maputo (Mozambique). (excerpt)
Strengthening the teaching of tuberculosis control in basic training programmes. A manual for instructors of nurses and other health-care workers.
Geneva, Switzerland, World Health Organization [WHO], 2006. 95 p. (WHO/HTM/TB/2006.367)Approximately one third of the world's population is infected with Mycobacterium tuberculosis and at risk of developing the disease. Every year, more than 8 million people develop active tuberculosis (TB) and approximately 1.9 million people die. More than 90% of global TB cases and deaths occur in the developing world, where 75% of cases are in the most economically productive age group (15--54 years). Once infected with M. tuberculosis, a person is infected for life. While only 1 in 10 of infected people with healthy immune systems will develop TB symptoms during their lifetimes, infected people with weakened immune systems, such as those with the human immunodeficiency virus (HIV), are at much greater risk of becoming ill with TB. At the same time, multidrug resistance, which is caused by poorly managed TB treatment, is a growing problem of serious concern in many countries throughout the world. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2006.  p. (WHO/HTM/ TB/2006.371; WHO/FCH/CAH/2006.7)This document complements existing national and international guidelines and standards for managing TB, many of which include guidance on children. It fills the gaps in the existing materials and provides current recommendations based on the best available evidence. National and regional TB control programmes may wish to revise and adapt this guidance according to local circumstances. This document reflects two important recent policy changes. Firstly, NTPs should record and report two age groups for children (0--4 years and 5--14 years) using the quarterly reporting form. Routine reporting of these two age groups has considerable benefits. Enumerating children with TB is a key step in bringing their management into the mainstream of the Stop TB Strategy as part of routine NTP activities. This age breakdown is crucial in ordering drugs (since child-friendly formulations are particularly important in children aged 0--4 years) and in monitoring of trends in these two distinct age groups (since children aged 0--4 years are the most vulnerable and infection at these early ages indicates recent transmission). In addition, routine NTP data collection will provide valuable and sustainable information on market needs concerning child-friendly formulations of anti-TB drugs. Secondly, the revised recommended dose of ethambutol is now 20 mg/kg (range 15--25 mg/kg) daily. Although ethambutol was previously often omitted from treatment regimens for children, due in part to concerns about toxicity (particularly optic neuritis), a literature review indicates that it is safe in children at this dose. (excerpt)
Instructions for applying to the Green Light Committee for access to second-line anti-tuberculosis drugs.
[Geneva, Switzerland], World Health Organization [WHO], 2006. 15 p. (WHO/HTM/TB/2006.369)Controlling multi-drug resistant tuberculosis (MDR-TB) is one of the six components of the WHO Stop TB strategy. Although prevention must be the highest priority for TB control programmes, many countries have patients with drug-resistant TB who must be treated too. Such countries should take specific measures to gradually incorporate appropriate strategies for treatment of this form of tuberculosis into their programmes and prevent propagation of drug-resistant TB. Misuse of second-line anti-TB drugs results in further resistance to these same second-line drugs, creating incurable forms of tuberculosis. It is imperative that second-line anti-TB drugs are used wisely. The WHO Guidelines For The Programmatic Management of Drug Resistant Tuberculosis (herein after referred to as the Guidelines) provide recommendations for appropriate management of drug-resistant TB so as not to generate further drug resistance. To help programmes develop and implement develop and implement strategies for the management of drug resistant TB, the Green Light Committee for Access to Second-line Anti-tuberculosis Drugs (GLC) was created by WHO and its partners in January 2000. (excerpt)