a. The 3^rd Stop TB DOT Expansion Working Group Meeting

"Expanding DOTS, reaching the global targets" (October 6 2002, Montreal)

This global workshop will provide an opportunity to update all participants on where countries stand today in DOTS expansion and to build solid alliances within the Global DOTS Expansion Plan.

The meeting aims to:

The Workshop will be preceded on October 5 by a meeting limited to invited members of the DOTS Expansion Working Group, including representatives of the 22 high-burden countries and the technical and financial agencies working with them to control TB.

The entire audience attending the 33rd International Union Against Tuberculosis and Lung Diseases (IUATLD) World Conference (October 6-10 2002) will have the opportunity to listen to country representatives, including those of the 22 highest burden countries on October 6.

The DOTS expansion Working Group (DEWG) has established two subgroups.

These are:

i) Public Private Mix-DOTS (PPM-DOTS)

ii) Laboratory Subgroup (LS)

i) Public-Private Mix (PPM DOTS)

This subgroup aims to address the issue of involving private health care providers in TB control.

A recent WHO global assessment in 23 countries across six regions in 2000, confirmed that the National TB Programme (NTP) is not the sole provider of TB care to the population in many countries. The assessment also found that even in places where NTP is the main provider, many people first approach a private health care provider. Many of these people also get diagnosed and treated in the private sector. However, no information is yet available on either the number of TB cases detected in the private sector or their treatment outcomes.

The mandate of the subgroup includes:

• to assist WHO and partners in the formulation of policy guidelines for countries and international partners on involving private health care providers in TB control, based on the evidence generated by field-based projects and country experiences
• to provide guidance on global, regional, country-specific and local PPM DOTS strategies
• to assist in development and implementation of a research agenda related to PPM DOTS
• to review progress achieved within the PPM DOTS initiative
• to identify resources to support PPM DOTS related research and demonstration projects and assist in global co-ordination.

The DOTS Expansion Working Group (DEWG) is set to establish a Laboratory Subgroup (LS) to assist high TB burden countries strengthen their provision of accurate and reliable services for TB control programmes.

The Laboratory Subgroup aims to provide:

1. a laboratory network as a dependable component of DOTS

2. accurate and reliable laboratory services through systematic and efficient quality assurance

3. training schemes and tools

4. good laboratory practices including standard operating procedures

The subgroup is chaired by Dr. Fadila Boulahbal (Algeria) and coordinated by staff from WHO, IUATLD, and KNCV.

The LS is set to assess the situation of TB laboratory services in several high burden countries and to develop assessment tools and an action plan to improve the capacity of the laboratory network.

c. News from EURO- The WHO European Region responds to the TB threat

The WHO Regional Office for Europe (EURO) has launched a major effort to expand DOTS to control the resurgence of TB with the formation of a regional strategic DOTS Expansion Plan.

For this first time the problem of TB in Europe was addressed as a high-level health priority for the whole region at the 52nd WHO Regional Committee in Copenhagen, Denmark (September 16-19, 2002).

The Member States committed themselves to place TB as one of the highest priorities on the health and development agenda in the WHO European Region and especially in the countries of concern. Consequently, political commitment to the implementation and expansion of DOTS will be strengthened throughout the region.

In the countries with high MDR-TB rates, the DOTS Plus strategy for the management of MDR-TB will be promoted and the access to high quality drugs for all forms of TB in all Member States will be ensured.

These measures, together with improved collaboration between TB and HIV programmes and health sector reform, will allow the European countries to fight TB effectively in a strong partnership between national, international, inter-governmental and non-governmental organisations and donors.

Over the last decade, the WHO European Region has experienced an alarming increase in tuberculosis, with more than 130 000 additional cases in 2000 compared to 1991. The majority of the new cases have occurred in central and eastern Europe as well as the newly independent states of the former Soviet Union. The epidemiological situation in the region is complicated, with increasing rates of HIV/AIDS and high rates of the multidrug-resistant form of tuberculosis (MDR-TB).

d. News from WPRO

The Stop TB Unit of WHO’s Western Pacific Region has launched Stop TB Web pages.

The new site includes basic information about:

The web team can be contacted on:

Core Group Meeting Date and venue: September 24-25 2002, WHO, Geneva

This Core Group meeting (CGM) in Geneva aims to accelerate progress of joint TB/HIV activities, evaluate progress of current joint plans, discuss recent events and establish recommendations for priority actions to the Working Group (WG).

The CGM will build on discussions from the second WG meeting held in June in Durban this year. As a result of the June meeting, WHO was urged to continue establishing the evidence base for TB/HIV interventions through phased implementation of nationally defined activities. The WG also asked WHO to urgently determine the feasibility of HAART in resource–poor settings. An update will be given of progress on these two issues at the CGM.

• An interactive CD-Rom of the Working Group meeting will also soon be available. This CD-ROM outlines the history of the Working Group, includes pdf versions of all WHO documents related to DOTS-Plus, as well as all the presentations of the Working Group meeting.

• The secretariat is organising monitoring visits to all 1st and 2nd round countries. Monitoring visits have already taken place to DPR Korea, Moldova, Myanmar and Kenya.
  
• Reports from all monitoring visits must be reviewed for completeness, consistency and credibility by an independent Desk Auditor. The Desk Auditor(s) for the GDF will have been appointed, through a competitive process, by October 2002. Once cleared through the desk audit process, monitoring reports will then be submitted to the GDF Technical Review Committee, which will make recommendation on continued GDF support to the relevant grantee.

• The process for the prequalification of manufacturers of TB products, initiated by the GDF and being coordinated by the WHO Department for Essential Drugs and Medicines Policy is well underway. Product dossiers from manufacturers that were shortlisted, were reviewed by a team of evaluators in mid-September 2002. Physical site inspections of the manufacturers began in late September. Sites in Kenya, India, Pakistan, Bangladesh and Malta will be evaluated during the last quarter of 2002, with additional inspections planned for the New Year. The first whitelist of prequalified TB manufacturers is expected to be published early in the New Year.

October 2002