Karin Weyer WHO Stop TB Department

1. Stop TB Partnership Global Laboratory Initiative Karin Weyer WHO Stop TB Department

2. Background • Health systems weaknesses one of the greatest challenges in TB control • Laboratory services one of the weakest links • Lack of diagnostic capacity a crucial barrier preventing an effective response to the challenges of HIV-associated TB and drug-resistant TB

3. Strengthening TB laboratories ‘From unimaginable…to indispensable’

4. To reach MDG targets, a global capacity need of 120 million smears, 60 mlllion cultures and 6 million DST investigations must be met by 2015, requiring at least 1 billion USD investment in laboratory infrastructure and annual variable cost # of tests required (mln) USD funding required (mln) 200 150 100 50 2500 2000 1500 1000 500 Urgent MDG Target Required expansion of Smear capacity: from 80 to 200 mln pa Required expansion of Culture capacity: from 10 to 60 mln pa 2008 2010 2012 2015

5. STP-Global Laboratory Initiative • WHA call for universal access to culture and drug susceptibility testing, May 2007 • Critical lack of TB laboratory capacity a global crisis • Paradigm shift required in laboratory policy guidance, coordination, quality management and knowledge creation • STP-GLI endorsed by CB October 2007

6. STP-GLI components • Integration of SLCS and SRLN • Global policy guidance • Laboratory advocacy and resource mobilization • Laboratory capacity development and coordination • Uniform standards, procedures, specifications • Multi-sectoral and disease cross-cutting approach • Coordination of technical assistance • Effective knowledge sharing

7. Key STP-GLI activities ~100.000 smear lab centers200.000-300.000 personnel ~8.000 advanced diagnostic centers40.000 – 50.000 personnel • Knowledge Sharing • Coordinating TA, training • Communication technologies • - Online knowledge resource network • Guidance • Laboratory policies • Laboratory manuals • Training materials • Resource mobilization • National roadmap advice 150 National Reference Labs 70 GLI Members WHO GLI Office • Assurance activities • - Coordination of EQA • Equipment specifications • Global accreditation system • Monitoring/evaluation • Interface Connection • Matchmaking projects between countries and implementing partners • National “roadmaps” • Advocacy • Other disease networks STP-GLI as an active facilitator of communication and provider of global infrastructure services synchronized to be a coherent network service 7 STP WGs Technical Agencies Other Laboratory Networks Other Diseases Capacity building (expanding SRLN, building diverse and flexible national, regional, international consultants base, systematic and structured training)

8. Training/Retention Strengthen Laboratory Capacity Logistics and Commodities Management Integrated systems approach CROSS-CUTTING STREAMS TIERED LABORATORY SERVICES Linked Referral Services Facility & Equipment Maintenance Quality Assurance Malaria Immun- ization HIV TB INTEGRATED SERVICE DELIVERY

9. Achievements • GLI Core Group* expanded • Technical guidance transitioned from volunteer efforts to • structured process of expert review and consensus • Increase in technical working groups • Draft GLI Business Plan • Laboratory resources • SLD-DST Policy Guidance and Technical Manual • Laboratory equipment specifications • Laboratory standard operating procedures • Biosafety Manual • Expansion of WHO Laboratory Team, GLI secretariat * WHO, Union, FIND, CDC, Patient Community, National TB Programmes, Supranational & National TB Reference Laboratories Observers, Liaisons with other Working Groups

10. Next Steps/Priorities • Refinement of estimates for escalating laboratory capacity under different epidemiological and resource scenarios • Modeling of anticipated impact of new technologies • Finalization of Business Plan priorities, supported by appropriate resource mobilization plan • Prioritization and costing of key activities • Standard-setting • Building laboratory management capacity • Creating conditions for accelerated laboratory strengthening, including private-sector involvement • Joint GLI-Fondation Merieux meeting, 11-12 April 2008