Stop TB Partnership Communiqué
Issue No.30
March 2003

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News from the Stop TB Partnership Secretariat (web site)

World TB Day, 24 March 2003 – First Impressions

"World TB Day 2003 – First Impressions" was compiled immediately after World TB Day 2003 to update members attending the Coordinating Board Meeting in Brasilia, Brazil. This document provides an overview of the events and activities that were planned and implemented worldwide to mark World TB Day 2003. It is based on information received at the Stop TB Partnership Secretariat in the days before and after 24 March 2003. Reports, photographs, press-clippings, commemorative mementoes and multimedia materials continue to arrive daily.

First impressions indicate that most countries developed and implemented a communications strategy that strongly focused on the theme of "DOTS cured me – it will cure you too!", and put cured TB patients centre stage as primary advocates for the campaign. Despite media preoccupation with recent events in Iraq, the hard work and creative energy of hundreds of partners across the world ensured that World TB Day activities left a distinctive mark on public consciousness – from the bold and radical set of "In Memoriam" advertisements released by KNCV in the Netherlands, to cricketing celebrities endorsing TB messages at the World Cup in South Africa; from press conferences involving high-level political and world leaders in London, Washington, DC, and other major capital cities, to the simple act of cured TB patients lighting an inaugural lamp at a function in Kerala – each event drove home the campaign’s key messages in its own unique way.

To support planning and preparatory activities, the Advocacy and Communications team issued a series of Web Alerts to partners and programme managers. These included tools and practical tips for designing and implementing a diverse range of interventions. A World TB Day questionnaire was also circulated as a tool for prompting systematic and comprehensive feedback from event organizers. An analysis of the events, activities and materials will take place over the coming weeks and be subsequently published in the form of a World TB Day 2003 Highlights Report. The First Impressions document and details of the events and activities listed therein are available at /events/world_tb_day/2003/default.asp.

Staff changes in the Secretariat

Satyajit Sarkar recently joined the Advocacy and Communication team as Campaigns Officer. Before this, he worked as Communications and Social Mobilization Consultant to the Polio Eradication Initiative in WHO SEARO and UNICEF India. Satyajit brings more than 17 years of hands-on experience in advocacy, programme communication, community mobilization, media productions, capacity-building and strategic planning, in the broad domain of development communications for social change.

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TB-Related News and Journal Items Weekly Update

The Centers for Disease Control and Prevention (CDC) provides the TB-Related News and Journal Items Weekly Update as a public service only. (Providing synopses of key scientific articles and lay media reports on TB does not constitute CDC endorsement.) The Update may also include information from CDC and other government agencies, such as background on articles in Morbidity and Mortality Weekly Report (MMWR), fact sheets, and press releases.

Those interested may subscribe, or change their subscriptions, by visiting the web site http://lists.asciences.com/mailman/listinfo/tb-update.

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Global TB Control Report 2003

The WHO Global TB Control Report 2003, published on World TB Day, is the seventh in a series of annual reports on global TB control. It includes data on case notifications and treatment outcomes from all national control programmes that have reported to WHO, together with an analysis of plans, finances, and constraints on DOTS expansion for 22 high-burden countries (HBCs). Eight consecutive years of data are now available to assess progress towards the 2005 global targets for case detection (70%) and treatment success (85%).

The number of countries implementing the DOTS strategy increased to 155 (out of 210) in 2001. DOTS programmes notified 2.4 million new TB cases, of which 1.2 million were smear-positive. The global case detection rate increased, but at 32% is still well below the 70% target. Treatment was successful for 82% of patients who started treatment under DOTS in 2000 – close to the 85% target. In the African Region, however, treatment success was substantially below average. Sixteen countries had reached targets for case detection and cure by the end of 2001, including Viet Nam, the only HBC among them.

Among the main national success stories, India doubled the proportion of infectious cases reported under DOTS; the Philippines reached the treatment success target and is approaching the case detection target; Myanmar and DR Congo have made good progress.

Countries face many constraints to DOTS expansion, the most common being lack of qualified staff; insufficient preparation for decentralization; non-compliance of the private sector with DOTS; inadequate health infrastructure; and weak political commitment.

The report concludes that if the current rate of DOTS expansion is maintained, the 70% detection target will not be reached by 2005. If that target is ever to be reached, DOTS programmes must improve case-finding within designated DOTS areas, and must expand to new areas. To reach the 85% target for treatment success, cure rates must be improved under DOTS in some countries, especially those in sub-Saharan Africa. Although funding for TB programmes, and planning for DOTS expansion, both improved during 2002, deficiencies in staffing and health infrastructure are likely to hinder progress towards both of the global targets.

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Executive Summary: TB and Poverty

The burden of TB disproportionately affects the poor. Globally, the highest burden of TB is found in poor countries. Of the 22 countries that account for 80% of the world’s TB burden, 17 are classified as low-income countries (GNP per capita of less than US$ 760, World Bank 2000). Within countries, the prevalence of TB is higher among the poor and other vulnerable groups such as the homeless. Studies in both high-income and low-income countries (Germany, Mexico, Norway, Philippines, United Kingdom, USA, Viet Nam) reveal significantly higher rates of TB in poor populations.

While TB is not exclusively a disease of the poor, deprivation associated with poverty increases the risk of infection and development of disease. There are clear associations between the risk of TB and malnutrition and overcrowding.

Recognition of the importance of poverty is increasingly reflected in international policy on health and development through, for example, the Report on the Commission for Macroeconomics and Health, Poverty Reduction Strategy Papers, Millennium Development Goals, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. In 2002, the Stop TB Partnership adopted "Stop TB, Fight Poverty" as its theme for World TB Day. Using this theme, the ways in which poverty and TB are associated and the mechanisms through which poverty increases the risk of infection and disease were summarized in a review of the literature by Christy Hanson in 2002, and further expanded last year by a Systematic Analysis by Bertha Nhlema of the EQUI TB Project in Malawi.

Poverty is multidimensional. Historically, poverty was conceptualized in terms of deprivation of income or basic needs. Today, the many social and material aspects of poverty are well recognized, and its definition has expanded to encompass notions of material well-being, an absence of infrastructure, lack of power and voice, and an unravelling of social structures. This review adopted an inclusive approach to the definition of poverty, and assessed how it has been used in the literature on TB. It was found that measures of poverty ranged from individual indicators to determine individual or household poverty status (based on income or assets), to aggregate indices assessing the poverty status of geographical areas to the identification, in different settings, of groups of people who are socially vulnerable (for example, the homeless, or migrant populations).

Tuberculosis has a severe impact on the impoverishment of patients and their households. The major factors that lead to impoverishment are the inability to work due to illness and the direct and indirect costs of accessing diagnosis and treatment. The pathway to TB care is characterized by many and repeated visits to different care providers, which are associated with both provider and patient. Poor and vulnerable people have longer pathways to care than other social groups. The direct and indirect costs of accessing care are generally higher before diagnosis than after diagnosis. Although the aggregate real costs are higher for non-poor patients, the relative costs for the poor are much higher. This is because they have little disposable income as a result of their livelihood activities, such as daily wage labour and petty. These costs add to the economic burden of households and lead to wider impacts, such as children replacing the activities of their ill parents, and an inability to support school fees. TB also has an impoverishing social impact. Fear and stigma are associated with TB in several settings, particularly for women.

DOTS has the potential to reduce the economic and social burden of TB for patients and their households. However, few studies have explicitly examined this question. Two studies in Indonesia and Uganda found that under DOTS, patient costs were reduced and patients were able to start working again. Studies from a number of developing countries reveal that the poor have much less access to TB or DOTS programmes than the non-poor, or can be excluded from TB care.

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News from the Stop TB Working Groups (web site)

DOTS Plus

POSTPONED: 4th Meeting of the Working Group on DOTS-Plus for MDR-TB, Seoul, Republic of Korea, 24-26 April 2003.
The meeting has been postponed until further notice due to the outbreak of Severe Acute Respiratory Syndrome (SARS) in parts of Asia.

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News from the Global Drug Facility (GDF) (web site)

GDF Applications/Review Update:

The Technical Review Committee reviews GDF grant applications and makes recommendations on grants to programmes. It also makes recommendations to WHO on necessary steps for programmes to meet conditions. The Committee currently comprises 15 members nominated by key stakeholders in the GDF, including potential donors, technical agencies and countries. Its composition reflects the need for expertise in several areas, including TB control, procurement, experience in TB programme management, and contracting.

The sixth Committee meeting took place from 11 to 13 March, at which 18 applications were reviewed, including 9 new applications from country programmes, 1 from an NGO working in cooperation with the country programme, 3 resubmissions and 5 from country programmes seeking a second year of support. The following applications were reviewed and discussed by the committee:

New applications
Benin
Botswana
Egypt
Gabon
Madagascar (regular and emergency)
Macedonia
Mali
Salfa (NGO): Madagascar (combined with the application from the NTP)
Turkmenistan
Yemen (regular and emergency)

Under consideration and resubmission countries
Bosnia and Herzegovina
Côte d’Ivoire
Eritrea

Monitoring countries
DR Congo
Djibouti
Somalia
Sudan
Tajikistan

The final recommendations of the Committee will be sent for approval by the Stop TB Coordinating Board in the week beginning 7 April, after which applicants will be informed.

Consultant’s Database: The GDF Secretariat is creating a database of consultants to take part in GDF country and monitoring missions. To be included in the database.

 

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GDF Procurement/Supply Update:

2003 has seen deliveries of TB drugs in five countries, Mauritania being the most recent to receive supplies on 1 February. A further 13 further countries will receive drugs in April and May 2003.

The new GDF procurement agent will be announced shortly.

The pre-qualification process for the production of a "white list" of TB manufacturers is in progress. An announcement is expected within the next couple of months.

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GDF External Evaluation Update:

The GDF, housed at WHO HQ for an initial two-year period, is currently undergoing an external evaluation by a team from McKinsey and Company to determine its future and governance. The team has visited Kenya, Republic of Moldova, Romania and Somalia as examples of first round countries, and second-round countries including India, Malawi, Myanmar, Nigeria, Philippines, South Africa and Uganda. The team is finalizing a draft report on the future and governance of the GDF, which has been presented at the Stop TB Coordinating Board meeting in Brazil this month, in April.

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GDF Forthcoming Events

March 2003

  • The Sixth Meeting of the Technical Review Committee, WHO, Geneva, 11-13 March
  • Country visit to Niger, 25-29 February
  • Monitoring Missions to Nigeria in March
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Calendar of Events (web site)

For more information on upcoming events, please click on the above link:

March/June 2003

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In Print

  • Global TB Control Report 2003
    The report is can be downloaded at the following url: http://www.who.int/gtb/publications/globrep/index.html . If you would like a hard copy, write to cdsdoc@who.int, with your complete postal address and phone number.
    (Document: WHO/CDS/TB/2003.316)
  • Executive Summary: TB and Poverty
    The findings and publications on TB and Poverty are recently published on a special CD-ROM, which can be ordered from the Stop TB Partnership Secretariat.
  • Cadre stratégique pour réduire la charge de la co-infection Tuberculosis/Hiv (portuguese version is also available)
    (Document: WHO/CDS/TB/2002.296)
  • Second meeting of the global working group on TB/HIV, 14-16 June 2002, Durban, South Africa
    (Document: WHO/CDS/TB/2002.311)
  • First meeting of the Public-Private Mix - Subgroup for DOTS Expansion
    (Document: WHO/CDS/TB/2003.317)

All documents are available from the CDS Information Resource Centre; fax: +41 22 791 4285; e-mail: cdsdoc@who.int.

- TB publications are also available at http://www.who.int/gtb/publications/TBCatalogue.htm.

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    'Stop TB' - a global movement to accelerate social and political action to stop the spread of tuberculosis around the world. For further information please contact the Stop TB Secretariat at: stoptbadvocacy@who.int