WHO-recommended Stop TB Strategy The global plan to Stop TB 2006-2015

1. WHO-recommended Stop TB Strategy The global plan to Stop TB 2006-2015 Prospect for reaching the MDGs GFATM preparation of round 6 Geneva 15-19 May 2006 Léopold BLANC TBS/STB WHO Geneva

2. The global incidence of Tuberculosis continues to rise as a result of the growing epidemic in Africa 600 AFR high HIV 500 400 300 Incidence per 100,000 per year AFR low HIV 200 Sth East Asia World West. Pacific 100 East. Medit. East. Europe Lat. America Cent. Euro, 0 Est Market 1990 1995 2000 2005 2010 2015

3. 5 targets for global TB controlMILLENNIUM DEVELOPMENT GOALS"to have halted and begun to reverse incidence.." Implementation (DOTS) Indicator 24 (target year 2005) Case detection >70% (> 6 m diagnosed) Treatment success >=85% (> 5 m cured DOTS) Impact Indicator 23 (target year 2015 cf 1990) Prevalence 50% of ≈ 300/100K Deaths 50% of ≈ 30/100K (< 1m deaths) Stop TB Department

5. DOTS Progresses the link with implementationOver 20 Million patients treated with DOTS since 1995

6. WHO-recommended Stop TB Strategy to Reach the 2015 MDGs • Pursuing quality DOTS expansion and enhancement • Political commitment • Case detection through bacteriology • Standardised treatment, with supervision and patient support • Effective drug supply system • Monitoring system and impact evaluation Additional components 2 Addressing TB/HIV and MDR-TB 3. Contributing to health system strengthening 4. Engaging all care providers 5. Empowering patients and communities 6. Enabling and promoting research (diagnosis, treatment, vaccine, OR) Stop TB Department

7. The Anchor of the WHO-recommended Stop TB Strategy: 1. Pursue quality DOTS Expansion & Enhancement • Political commitmentwith long-term planning, adequate human resources, expanded & sustainable financing to reach WHA and MDG targets • Case detection through bacteriology(microscopy first, culture/DST) and strengthening of the laboratory network to facilitate detection of SS+, SS-, DR- and MDR- TB cases • Standardized treatment, under proper case management conditions, including D.O.T. to reduce the risk of acquiring drug resistance, and patient support to increase adherence and chance of cure • An effective and regular drug supply system, including improvement of drug management capacity • Efficientmonitoring systemfor programme supervision and evaluation including measurement of impact Stop TB Department

8. Other 5 Components of the WHO-recommended Stop TB Strategy • Addressing TB-HIV, MDR-TB and other special challenges, by scaling up TB/HIV joint activities, DOTS Plus, and other relevant approaches • Contributing to health system strengtheningby collaborating with other health programmes and general services in, e.g., mobilizing the necessary human and financial resources for implementation and impact evaluation, and by sharing and applying achievements of TB control • Engaging all care providers, public, non-governmental and private, by scaling up public-private mix (PPM) approaches to ensure adherence to the International Standards of TB Care, with a focus on the providers of the poorest • Empowering patients and communities by scaling up community TB care and creating demand through context-specific advocacy, communication and social mobilization • Enabling and promoting research to improve programme performance and for developing new drugs, diagnostics and vaccines Stop TB Department

9. From DEWG activities to MDG impact Inputs Process Outputs Impact Planned activities 1. DOTS coverage 2. DOTS quality package: -HR strategy -Supervision -Quality microscopy -Drug management -IEC 3. PPM DOTS 4. Community DOTS 5. PAL 6. Culture and DST 7. Pro-poor strategy • Improve TB management • Improve diagnostic quality • Improve case management • Improve referral routines • Improve recording and reporting • TB control outcomes • Increase case detection • Improve treatment success rate • MDG6 • TB control impact • Reduce TB incidence • Halve TB prevalence • Halve TB death rate • Adapt services to the poor • Involve communities • Involve providers that serve the poor • Provide free services • Reduce unnecessary tests • Decentralize DOT • Equity outcomes • Reach all patients, especially the poor • Decrease diagnostic delay • Reduce patients' direct and indirect costs MDG1 Poverty impact Halve poverty and hunger Reduce poverty and hunger among people with TB and their families

10. The "optimistic and realistic" scenario • Optimistic: Enough resources for efficient implementation of existing and new tools and strategies with expected positive impact on case detection and treatment success rates. • Realistic: Accounting for general systems barriers that may not be overcome during 2006-2015

11. Steps in developing DEWG plan • Define and cost activities: 1. DOTS coverage 2. DOTS quality package: 3. PPM DOTS 4. Community DOTS 5. PAL 6. Culture and DST 7. Pro-poor strategy (part of all above) • Estimate expansion pace of activities (countries - regions) • Estimate effect of scaled up activities on case detection and treatment success ("common sense", no modelling) • Incorporate TB/HIV and DOTS plus interactions • Estimate effect on MDG targets (modelling)