Stop TB Partnership

Global Drug Facility (GDF) Missions Update

GDF Technical Assistance Mission to Kazakhstan: 19-24 February 2018

GDF conducted a technical assistance mission to Kazakhstan from 19-24 February 2018 following a request from the National TB Programme (NTP). During the mission, GDF has started the development of the National TB Pharmaceutical Management Guideline which will cover all aspects of TB drug management, including an improved system for quantification, forecasting and early warning using the QuanTB tool on the county (oblast) and central levels. The current TB pharmaceutical management system was assessed to be considered in the review of the National TB Pharmaceutical Management Guideline. To assist NTP maximizing the coverage and uptake of new TB drugs GDF conducted an exercise for quantification and forecasting of needs for 2018-2020, including demand for all pre-XDR and XDR-TB cases and also elaborated several scenarios to be reviewed by the Ministry of Health and the Global Fund.

Uptake of new TB medicines in Kazakhstan has been slow due to legislation in force and treatment success rate for XDR TB cases is low. Currently, provision of new medicines (Bedaquiline, Delamanid) and repurposed medicines (Linezolid, Clofazimine) for effective treatment of pre-XDR and XDR-TB cases is possible only within the EndTB project and the Global Fund grants where the NTP is the sole Principal Recipient. At the same time, the NTP with the Global Fund support plans the introduction of shorter drug-resistant TB (DR-TB) treatment regimens in 2018. TB pharmaceutical management in the country is regulated by several laws and governing acts and decrees, but a comprehensive document that would guide NTP in TB medicines selection, procurement, distribution and use is still lacking. The NTP also foresees challenges in the supply planning considering existing quantification and forecasting system which is not suitable for the highly individualized treatment regimens used in the country.

GDF Technical Assistance Mission to Ethiopia: 12-22 February 2018

GDF conducted a technical assistance mission to Ethiopia from 12-22 February 2018. The country has successfully signed the Global Fund grant for 2018-2021 and has commenced the early stages of implementation. During quantification exercises using the QuanTB tool coordinated by GDF, the early warning system identified some quantities of adult first-line TB medicines ordered using the country’s procurement mechanism to be at risk of expiry. To avert this risk, GDF recommended a bi-annual shipment plan for these products and also advised a reduction adjustment in the min-max stock levels. The main contributing factor to this risk identified during the mission was the change in the product shelf life from 3 to 2 years which varies based on suppliers.

The mission team observed a challenge in the quality of data reported on the "number of patients enrolled per medicine use" which is key for reordering of supplies. To address this challenge, the team designed and recommended the use of a patient per medicine data validation tool. The tool is expected to strengthen the second-line TB medicines supply system by limiting errors in data collection and reporting. The country laboratory team is pleased with GDF’s initiative at sourcing diagnostics for TB as it serves as a one-stop-shop for the procurement of culture and DST diagnostics including GeneXpert machines and cartridges for the country. Presently the country has 288 Xpert machines (146 installed and 142 soon to be installed).

Iraq Procurement and Supply Chain Desk Review Meeting for TB Commodities: 28-30 January 2018

GDF participated in a procurement and supply chain three-day desk review mission from 28-30 January 2018 along with participants from the National TB Programme from Iraq, KIMADIA (the State Company for marketing drugs and medical appliances in Iraq), International Organization for Migration (IOM), and WHO. IOM is the Global Fund’s Principal Recipient for the Middle East Response and hosted the meeting in Amman, Jordan. Participants undertook a full review of the supply chain situation for first-line and second-line anti-TB medicines in Iraq, as well as for TB diagnostic products. In addition to discussing the Procurement and Supply Management (PSM) transition plans for the new paediatric formulations, shorter multidrug-resistant TB (MDR-TB) regimen, and implementation of new extremely drug-resistant TB (XDR-TB drugs), participants also discussed solutions to supply chain challenges specific to the context of the country. Participants agreed quantification figures to be used for procurement and supply planning. The desk review concluded in the need for regular reviews to monitor case enrollment and stock levels of TB medicines and so anticipate problems that need intervention in the future.