Stop TB Partnership

Global Drug Facility Technical Assistance update for May


29 May 2017 - The Stop TB Partnership’s Global Drug Facility (GDF) participated in the TB program review mission in Cameroon from 27 March to 7 April 2017 to cover the procurement and supply management (PSM) aspects and to offer specific technical assistance in reviewing the implementation plan for the new TB medicines and the shorter MDR-TB treatment regimen. bedaquiline was already introduced in Cameroon in 2016 as part of the XDR-TB treatments, and the first patient on delamanid is expected to start treatment in 2017. The new child friendly pediatric formulations are being introduced and should benefit at least 1400 children with better TB treatments over the next year. A lot of investment was made to improve PSM for TB medicines. However further training, consolidation and coordination of all the steps along the supply chain are still required to improve the overall PSM performance. The main challenge identified during the program review is the need to secure domestic funding to procure 100% of first-line and 40% of second-line TB medicines to prevent treatment interruption in the coming year.

The Stop TB Partnership’s Global Drug Facility (GDF) conducted a technical assistance mission to Kazakhstan from 1 - 7 April, 2017. The overall objective was to strengthen the National TB Programme (NTP) and its partner KNCV country office’s capacity on quantification, and monitoring of the introduction of new TB tools in a rational manner and roll-out the early warning system to prevent stock-out and overstocking. GDF facilitated training on Forecasting, Quantification, Supply Planning and Early Warning system for representatives of the central and regional (oblast) TB facilities and the principal recipient of the Global Fund TB grant. GDF worked with the Global Fund Principal Recipient to finalize the PSM plans for the introduction of new TB medicines and shorter MDR-TB regimens (STR) for the cohort of patients under Global Fund grants (civilian and penitentiary). PSM plans to start new child-friendly formulations for all paediatric TB patients countrywide were finalized and respective procurement orders for these formulations and also for second-line medicines were developed. The key recommendations were for the NTP to conduct regular supervisory visits to all TB facilities and provide technical assistance to local staff and monitoring the EWS implementation; Global Fund principal recipient to maintain a database for cohort of patients under the Global Fund TB grant, stock monitoring and conducting quantification for TB medicines quarterly; and the Global Fund portfolio to speed up the process of grant re-programing to ensure expedited uptake of STR and new pediatrics.

The Stop TB Partnership’s Global Drug Facility (GDF) conducted a technical mission in Angola from 24 April to 3 May 2017. The main objectives accomplished during the GDF mission were to support the NTP in planning for procurement of first-line and second-line TB medicines for 2017 and 2018 based on accurate quantification; review and update the transition plans for the introduction of new TB medicines, regimens and new child-friendly paediatric formulations and discuss PSM-related issues; and to define optimized procurement frequency based on the country context to prevent stock-out and overstocking. GDF also conducted a demonstration of the new version of the QuanTB tool for NTP and partners, including identification of key data needed, to improve their skills for proper forecasting, quantification, supply planning and early warning system. During the mission, GDF performed supervisory visits to health facilities and central medical warehouse to assess and map the in-country supply chain for TB medicines and diagnostics, including the national regulatory processes and systems, and discussing options to ensure timely access to quality-assured anti-TB medicines.

Stop TB Partnership's Global Drug Facility (GDF) contributed to the Swaziland Mid-Term Review of TB, HIV and PMTCT programmes based on Strategic Plans from 1 - 12 May, 2017. GDF support has focused on the supply chain management of TB products and it was a timely step in the right direction. A review of the stock positions using the QuanTB tool revealed potential risk of wastage that could be mitigated with proper actions. Using the slogan "If you can see ahead of time then you can prevent it", GDF was able to alert, amongst other issues, the potential risk of expiries for 2018/2019. The output was well appreciated by the country. The good news is that the country has sufficient time to plan to reduce the wastage and has shown the benefits of using efficient early warning systems. They are also willing and ready to utilize the QuanTB tool regularly by themselves once trained. Adequate utilization of the tool in addition to other key management strategies would help avoid future occurrences. The Stop TB Partnership's Global Drug Facility (GDF) conducted a mission in Pakistan from 2 - 11 May 2017. The main objectives of the GDF mission were to review quantification, monitor implementation of new TB tools, particularly, accelerated introduction of the shorter MDRTB regimen (STR) following recent advocacy from WHO to countries and partners, and to provide support on PSM aspects of the Global Fund funding request for 2018-2020 among others. GDF supported the quantification of first-line and second-line TB medicines in close collaboration with NTP, Global Fund and other partners, taking into account increased pediatric case notification, a transition plan for the STR, expansion of bedaquiline-containing regimens and implementation of delamanid. GDF reviewed existing orders for 2017 and supported the NTP to timely place new orders for 2018 needs. GDF also discussed the implementation of regular processes for data collection, validation and consolidation needed at provincial level and the subsequent consolidation at central level for proper quantification as key to maintain a functional early warning system to prevent stock-outs and overstocking. To increase country’s capacity and ownership, GDF is planning along with NTP and partners, the Pakistan Workshop on Forecasting, Quantification, Supply Planning and Early Warning System to be held tentatively in Q3-Q4 of 2017.

The Stop TB Partnership’s Global Drug Facility (GDF) conducted a mission in Burkina Faso from May 15 to 26, 2017 to support National TB Programme (NTP) and in-country stakeholders during the grant-making process for the Global Fund. GDF supported the development of the health products list for TB taking into account the current treatment protocols and future activities. Based on the recommendations of the TB programme review mission which took place in January 2017, GDF also supported the development of the procurement and supply management (PSM) plan for first and second-line TB medicines, and preventive therapy (LTBI), including quantification for 2017/2018 and the recommended optimized procurement frequency based on the country context to prevent stock-out and overstocking.

UPCOMING ACTIVITIES

Stop TB Partnership's Global Drug Facility (GDF) will conduct a technical assistance mission to Vietnam from 5 - 14 June, 2017. This mission has been prepared at the request of the NTP and the Global Fund and the main objectives are to support the quantification and procurement planning of TB medicines, discuss PSM transition plans for new tools, review the current regulatory system to smooth procurement of TB commodities, review the progress made for the introduction of new, optimized paediatric formulations, and discuss procurement plans for transition from external funding to domestic funding, among others.

A joint GDF and Global Fund mission will be conducted to Malawi from 7 - 16 June, 2017. This mission has been organized together with the Global Fund Country Team and main objectives are to support the quantification and procurement planning for the Global Fund grant making, discuss PSM transition plans for new tools, review the current regulatory system and discuss procurement plans for transition from external funding to domestic funding, among others.

GDF will conduct its first regional workshop for the francophone Africa region on Forecasting, Quantification, Supply Planning and Early Warning System for TB Medicines from 12 - 16 June 2017 in Dakar, Senegal. 26 PSM experts are expected to attend from 13 different countries: Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Côte d'Ivoire, Democratic Republic of Congo, Guinea, Madagascar, Mali, Morocco, Niger and Senegal. The objectives are to improve procurement and supply management (PSM) practices for TB medicines in countries and ensure rapid and rational uptake of new TB tools. This will be achieved by developing participants’ capacity to accurately quantify their needs, implement an early warning system (EWS) and optimized procurement with more frequent deliveries to prevent stock-outs and over stocking, considering external and domestic funding to ensure quality of medicines and sustainability. GDF will use the latest version of QuanTB to enable this work and support the participants in analyzing their country situation regarding procurement of TB medicines. The workshop is also an opportunity to south-to-south exchange of experience, knowledge, resources and best practices in PSM for TB commodities.

GDF will participate in the TB program review in Niger from 19 - 30 June 2017 along with the Global Fund, WHO and the Union. During the mission, GDF will lead the PSM activities and review the transition plans for new pediatric formulations, shorter MDR-TB treatment regimen and new medicines, including bedaquiline and delamanid. The mission will also give an opportunity to discuss the overall technical assistance required by the NTP to ensure efficient procurement of TB commodities.