WHO/ERS Digital Health Agenda for the End TB Strategy
Dennis FALZON, MD Global TB Programme, WHO/HQ, Switzerland
21st Annual Conference of the Union North America Region Vancouver, BC, Canada
February 25, 2017
Speaker conflict disclosure: none The presenter is a staff member of the World Health Organization (WHO). The Global TB Programme of WHO is supported by USAID, the European Respiratory Society, the Global Fund to Fight AIDS, TB and Malaria, and BMGF for activities in support of digital health for TB control. The funders were not involved in the preparation of this presentation.
Objectives of the presentation
• Outline the agenda document and events leading to its creation
• Present the vision of WHO and partners on future action along the path mapped by the agenda
WHO/ERS consultation, February 2015
Experts from different areas: digital health developers, TB, clinical, public health, national TB programmes, technical agencies, donors
-> Global task force for digital health and TB
-> Conceptual framework for digital health & TB
-> “Agenda for action”
-> Target product profiles
WHO global task force on digital health and TB
To advise WHO/GTB on:
• the development of digital health products that are aligned to the challenges posed by TB to health care providers and patients
• the approach to the review of evidence and best practices for the effectiveness of digital health interventions in TB care and control
• how to support WHO Member States to scale up digital health technologies for TB care and control based on existing knowledge
Patient care
Surveillance eLearning
Programme management
Conceptual framework for digital health & TB
“… if your initiative isn't increasing effectiveness or efficiency (or both) then you shouldn't be doing it.”
John BONTEMPO linearityofexpectation.blogspot.ch
What evidence?
PILOT PROJECT
STUDIES
CONCEPT
EVIDENCE REVIEW
POLICY CHANGE
How scalable? the ability to handle a growing amount of work in a capable manner or its ability to be enlarged to accommodate that growth
Estimated incidence, 2015
Estimated number of deaths, 2015
1.4 million* (1.2–1.6 million)
10.4 million (8.7–12.2 million)
580,000 (520,000–640,000)
All forms of TB
Multidrug- / rifampicin-resistant TB (MDR/RR-TB)
HIV-associated TB 1.2 million
(1.0–1.3 million)
390,000
(320,000–460,000)
Source: WHO Global Tuberculosis Report 2016 * Excluding deaths attributed to HIV/TB
250,000 (160,000–340,000)
The global TB situation
Integrated, patient-centered TB care
and prevention
Bold policies and supportive
systems
Intensified research
and innovation
End TB Strategy Pillars & Principles
The «Agenda for Action» & the End TB Strategy
“Agenda for action”
The strategic direction that WHO is mapping out to integrate digital health into preventive and care activities for the different components of the End TB strategy Comments on the evidence and an outline of the target product profiles
Sep 2015
Target product profiles (TPP) (1) for priority digital technologies for TB
Function TPP : short description
Patient care 1. Video treatment support (VOT) via mobiles
2. eHealth portal
Surveillance &
monitoring
3. Graphic dashboards
4. eNotify
5. eReporting of adverse events of treatment
Programme
management
6. Diagnostic device connectivity
eLearning
7. Patient information platform
8. Web-based training for health care professionals
9. Clinical decision support systems
ERJ; 2016
Target product profiles (TPP) (2) for priority digital technologies for TB
WHO/ERS events at scientific meetings 2015-2017
• ERS Summit (Brussels, Jun 2015) • ERS Congress (Amsterdam, Sept 2015) • UNION World Conference (Cape Town, Dec 2015) • UNION Eur. Region Conference (Bratislava, Jun 2016) • ERS Congress (London, Sept 2016) • UNION World Conference (Liverpool, Oct 2016) • UNION N. American Region Conference (Vancouver,
Feb 2017)
Implementation guide on the digital technologies being used of connect GeneXpert machines and other diagnostic platforms
Oct 2016
Electronic case-based surveillance e.g. DHIS2 for dis-/aggregated recording
Benin (October 2015; May & October 2016) ^ Kampala (December 2016)
eLearning apps e.g. PAL in Belarus
mHealth for TB-Tobacco: A technical workshop Cairo, February 2016
Outcome: a library of text messages on TB and tobacco which can address patients and health care workers
2nd WHO/ERS technical consultation, 7-8 February 2017
1. Evidence 2. Country experience 3. Funders’ perspectives 4. Concepts for tomorrow
Precision medicine and other future perspectives • Other approaches to adherence support not
currently covered by existing TPPs (e.g. medication monitors, ingestible devices)
• Nanotechnology for TB treatment delivery and TDM
• Artificial intelligence to extend the reach of today’s products
• Drones as a means to improve programme logistics and articulate with various digital technologies
Conclusion • Vast potential of digital health in action against major
diseases like TB
• WHO started process of evidence-based policy on use of digital technologies
• Evidence base for role in TB efforts is emerging but challenged by resources, rapid evolution of technologies, study design, concepts like precision medicine … in some areas the evidence will probably be limited to contextual narratives
• Nonetheless clinicians, managers, patients are bound to employ digital technologies and therefore the demand for evidence is likely to grow
Acknowledgements (1) • N American UNION Conference
organisers for inviting WHO
• Global task force on digital health for TB
• National TB programmes
• European Respiratory Society
• Many other technical and funding partners
• WHO colleagues
Acknowledgements (2) Collaborative group on the impact of digital technologies on TB (alphabetical order)
I Abubakar, N Alipanah, M Bastos, D Boccia, T Cohen, D Chin, J L Davis, C Denkinger, D Falzon, K Fielding, G J Fox, C Free, R S Garfein, A Hayward, E Jaramillo, B Kermu Ngwatu, R Lester, J Lewis, B Mappin-Kasirer, F Marx, D Menzies, GB Migliori, P Nahid, L N Nguyen, P N Nsengiyumva, O Oxlade, K Siddiqi, K Schwartzman, A Story, A Trajman, B V Thomas, M Yassin