JOINT PARTNERS FORUM FOR STRENGTHENING AND ALIGNING TB DIAGNOSIS AND TREATMENT

Geneva 29 April 2015

Daniel Orozco BSc, MPH Head of Access FIND

Addressing the MDR-TB crisis Bottlenecks in reaching people with MDR-TB

Logframe Indicators GOAL (Impact): To improve case detection and management of MDR-TB

in targeted countries. Indicator G1.1: Number of MDR-TB patients detected

Purpose (Outcome): Increased access to rapid diagnostics for patients at risk of MDR-TB in target countries.

Indicator P1.1: Number of laboratories where new diagnostic technologies are introduced according to the countries' needs as assessed initially

Indicator P.1.2: Number of countries supplied with the diagnostic tools and integrated into the National TB Control program diagnostic algorithms

Outputs: 1- Access: Expand and accelerate access to quality assured new TB diagnostic

technologies.

2- Procurement: Supply of affordable TB diagnostics to eligible countries

3- Market Impact: Leveraging price reductions for diagnostic tools, instruments, reagents, and supplies.

4- Transition: Transitioning out to ensure continuation of use of new TB diagnostics after Project conclusion

27 countries

Challenges During Lab Preparedness phase:

• political commitment,

• coordination between ministries and agencies involved in a project,

• costly infrastructure and biosafety upgrades.

During technology transfer phase: • human resources,

• complex nature of diagnostic and biosafety technologies,

• complex importation regulations,

• new technology validation requirements in selected countries.

During routine testing and monitoring phase • coordination and cooperation at the national level,

• limited possibilities for equipment maintenance

• poor sample transportation systems.

EXPAND-TB key results

101

107’

X5

26%

101 of 103 targeted laboratories fully operational by end 2014 and using novel rapid tests

>107,000 MDR-TB cases detected in 27 project countries between 2009 and 2014

Number of MDR-TB cases notified by the 27 countries increased 5 folds between 2009 and 2014

26% of MDR-TB cases detected globally with EXPAND-TB project support

Building laboratory capacity

101 laboratories upgraded and

using new rapid diagnostics

>3K laboratory staff trained (over

300 training sessions)

reduced time to results

Cumulative MDRTB cases detected

What has enabled these results • Goal: to expand access to new diagnostics for

TB in 27 low- and middle-income countries (High TB and MDRTB burden countries

• Funding from UNITAID: US$ 87 million grant approved in 2008

• Targeted countries carry 41% of the estimated global burden of MDR-TB.

• Successful partnership: UNITAID, WHO-GLI, FIND and GDF

Global Impact

ExTB participating countries

123,173 (41%)

Globally except ExTB participating

countries 176,627 (59%)

Estimated MDR-TB Cases among Notified pTB Cases Globally in 2013

Estimated Gap among notfied TB

cases 103,976

(59%)

MDR-TB notified 72,651 (41%)

MDR-TB notifications and estimates among TB notified cases GLOBALLY, except EXPAND-TB participating countries

Estimated GAP among notfied TB

cases 59,412 (48%)

MDR-TB Notified 63,761 (52%)

MDR-TB notifications and estimates among TB notified cases among EXPAND-TB participating countries

EXPAND-TB participating

countries 63,761 (47%)

Globally except EXPAND-TB participating

countries 72,651 (53%)

Notified MDR-TB Cases in non-participating and participating ExTB countries Globally in 2013

0

10000

20000

30000

40000

50000

60000

70000

80000

2005 2006 2007 2008 2009 2010 2011 2012 2013(MDR-/RR-TB)

Notified MDR-TB Cases among participating and non-participating EXPANDx-TB countries worldwide

Globally except EXPAND-TB participating countries EXPAND-TB participating countries

Global Impact

Start of EXPAND-TB project

Global Impact

0

10000

20000

30000

40000

50000

60000

70000

2005 2006 2007 2008 2009 2010 2011 2012 2013(MDR-/RR-TB)

Contribution of EXPAND-TB project in MDR-TB cases notification by EXPAND-TB participating countries

MDR-TB detected through ExTB Notified MDR-TB cases (absolute)

Start of EXPAND-TB project

Detected through EXPAND-TB project

35,736 26%

Not detected through

EXPAND-TB 100,676

74%

Contribution of EXPAND-TB Project in Global MDR-TB Case Notifications in 2013

Detected through EXPAND-TB project

35,736 56%

NOT detected through EXPAND-TB

28,025 44%

Contribution of EXPAND-TB project in MDR-TB case notifications within all paticipating contries in 2013

0

10000

20000

30000

40000

50000

60000

70000

2005 2006 2007 2008 2009 2010 2011 2012 2013(MDR-/RR-TB)

5526 9314

11116 9861

13404

18948 23668

36108

63761

Trends in MDR-TB cases Notifications and MDR-TB Treatment Initiations of the 27 EXPANDx-TB Countries Combined (WHO data 2005-2013)

Patients started on MDR-TB treatment Notified MDR-TB cases (absolute)

Start of EXPAND-TB project

46494

Dx/Tx alignment

Political commitment

• The new TB diagnostic tools have been incorporated into national policy in all 27 countries.

• Guidelines and testing algorithms updated

• MoU signed with all countries (FIND-MoH / GDF-MoH)

• Coordination with partners for streamlining support

Shaping the market for new TB diagnostics and drugs

• Decreased price for liquid culture, DST, molecular tests and ancillary laboratory items

• Expanding the market by new or upgraded 100+ laboratories

• Attracting new suppliers and creating potential for competition

• Increased procurement of second-line drugs

• Up to 32% drops in the price of individual medicines and MDR-TB treatment regimens

SUSTAINING THE ACHIEVEMENTS • Patient centered approach • Supporting HR, NTPs, MoH

Commodity's provision (GF, in-country resources and other mechanisms)

• Network of technical assistance available for other programs (Challenge TB, endTB..)

• New technologies coming through the pipeline • Expand DST central capacity (2nd line LPA, New drugs) • Collecting evidence for molecular technologies • Help countries in selecting appropriate tools • Implement connectivity (link diagnostics to care)

Conclusions

• 107,000 MDR TB cases diagnosed

• Successful implementation in 101

laboratories /27 countries

• TA network developed to support

country operations

Conclusions • Tools developed for procurement, cost, SOPs, training

materials etc

• Political support (MoH & NTPs)

• Market impact: Increase demand and reduced

commodity costs

• Positive impact on time to treatment and change in

national policies

• Global success!

Annual and cumulative targets exceeded Acknowledgements

• GLI / WHO

Alexei Korobitsyn

Wayne Van Gemert

Christopher Gilpin

Jean Iragena

Fuad Mirzayev

Karin Weyer

• GDF

Thomas Verges

• UNITAID Robert Matiru Yamuna Mundade • Country counterparts (MoH/NTP)

• SRLs

• Other partners

• FIND

Catharina Boehme Diana Gomez

Sandy Haldimann

Kekeletso Kao

Rais Mazitov

C.N. Paramasivan

Jesse Wambugu

Jeff Lemaire

• FIND/GLI consultant network

• Local Counterparts

MoH

NTPS

Labs (Central and peripheral)

• Global Fund (Transition phase)