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Planning framework: Management of Drug Resistant TB

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EllenMixel
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Planning framework: Management of Drug Resistant TB. Fuad Mirzayev, GLC Secretariat, WHO Stop TB workshop on TB proposal preparation for round 6 of the GFATM 15-18 May 2006, John Knox Center, Geneva. Round 6 - New Environment. Guidelines for the programmatic management of DR-TB

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  1. Planning framework: Management of Drug Resistant TB Fuad Mirzayev, GLC Secretariat, WHO Stop TB workshop on TB proposal preparation for round 6 of the GFATM 15-18 May 2006, John Knox Center, Geneva

  2. Round 6 - New Environment • Guidelines for the programmatic management of DR-TB • Standards of TB care • New Stop TB strategy • Global plan to Stop TB 2006-15 – 800,000 MDR-TB patients to treat

  3. http://whqlibdoc.who.int/publications/2006/9241546956_eng.pdfhttp://whqlibdoc.who.int/publications/2006/9241546956_eng.pdf

  4. Collaboration with the GFATM "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 “The board reaffirms its decision taken at its Third Board Meeting… The Board decides that applicants… must include a cost-sharing element for Green Light Committee services. To limit transaction costs this will be defined by the secretariat in consultation with the Green Light Committee as a flat rate per grant per year that will not exceed US 50,000$ per grant per year. “ Thirteenth Board Meeting, 27-28 April, 2006 The Global Fund to Fight AIDS, Tuberculosis and Malaria

  5. Azerbaijan Bangladesh Bolivia Cambodia Costa Rica DR Congo Dominican Republic Ecuador Egypt El Salvador Estonia Georgia Guinea Haiti Honduras India Jordan Kenya Kyrgyzstan Latvia Lebanon Lithuania Malawi Mexico Moldova Mongolia Nepal Nicaragua Peru Philippines Romania Russia Syria Timor Leste Tunisia Uzbekistan GLC approved projects GLC-approved projects in 36 countries

  6. Azerbaijan Armenia Bangladesh Bolivia China* Dominican Republic DR Congo Ecuador Egypt El Salvador Georgia Honduras India Indonesia* Jordan Kenya Kyrgyzstan Moldova Mongolia Nicaragua Paraguay Peru Philippines Romania Russia Serbia* Uzbekistan The crucial role of the GFATM GFATM approved proposals with MDR-TB component (27)

  7. GLC model*: components Monitoring and evaluation Expert committee Procurement Services GLC secretariat *Gupta R, Irwin A, Raviglione MC, Kim JY Lancet 2004;363: 320-324

  8. GLC model: action cycle Country/Project WHO GDF GLC secretariat Expert committee GLC Procurement M&E Pharmaceuticals

  9. Stop TB strategy – component 2: Prevent and control MDR-TB • Prevent deaths and continued transmission of drug-resistant strains and creation of incurable forms of tuberculosis • Integrate drug resistance surveillance and management of MDR-TB as routine components of TB control

  10. Activities > MDR SDAs (1) • Laboratory Support • (not only bacteriology lab) • DRS • (important for the project design and selection of treatment strategy and drug forecasting) http://whqlibdoc.who.int/publications/2003/9241546336.pdf

  11. Activities > MDR SDAs (2) • Technical assistance • (different from GLC services) • Health Facilities • (both in-patient and out-patient facility) • Infection control • Human Resources http://www.who.int/docstore/gtb/publications/healthcare/PDF/WHO99-269.pdf

  12. Activities > MDR SDAs (3) • GLC services • (50,000 flat rate per grant per year) • Procurement of medicines • (SLDs – 2,000-3,000 US$ on average, drugs to treat adverse effects 5-10% from SLD cost, shipment costs) • Social support http://whqlibdoc.who.int/hq/2004/WHO_HTM_TB_2003.328_Rev.1.pdf

  13. Requirements outlined in the Guidelines are in place DR-TB situation is well defined Small projects may utilise services of the external laboratory Laboratory provides sufficient capacity and quality Key stakeholders of the project identified • Project protocols prepared including: • - Treatment strategy • R&R system • training plan • drug management plan • Lab quality assurance • Social support Application to GLC – review and approval Drug procurement using GLC mechanism for quality assured, preferentially priced drugs Project implementation Sequence of events

  14. Timing of GLC application • Based on “Instructions” and follow principles outlined in the “Guidelines” • Not necessary to be submitted with GFATM proposal, but… • Preparation has to start well before the planned initiation of MDR-TB patients enrollment (factoring application writing, GLC review, procurement lead times, importation) • Baseline situation very important, incremental approach vs. whole country projects.

  15. Questions? Fuad Mirzayev mirzayevf@who.int