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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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Planning framework: Management of Drug Resistant TB

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Planning framework management of drug resistant tb l.jpg

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


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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


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


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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


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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


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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)


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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


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GLC model: action cycle

Country/Project

WHO

GDF

GLC secretariat

Expert committee

GLC

Procurement

M&E

Pharmaceuticals


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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


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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


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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


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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


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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


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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.


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Questions?

Fuad Mirzayev

mirzayevf@who.int


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