WPRl2008IDCC/06-E
Report series number: RS/200S/GElOS(AUS)
English only
REPORT ,rURTH PACIFIC STOP TB MEETING
Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC Brisbane, Australia 11-14 March 200S
WHU/Wl'RO LlUl{ARY
MANILA, PHILIPPINES
o5 r~tr: 2009 Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines February 2009
NOTE
The views expressed in this report are those of the participants of the Fourth Pacific Stop TB Meeting and do not necessarily reflect the policies of the Organization.
This report has been printed by the World Health Organization Regional Office for the Western Pacific for governments of Member States in the Region and for those who participated in the Fourth Pacific Stop TB Meeting, which was held in Brisbane, Australia from II to 14 March 2008.
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SUMMARY
With an estimated 1600 new tuberculosis (TB) cases every year, the burden ofTB in the 20 Pacific island countries and areas, excluding Papua New Guinea, is relatively small. However, in several Pacific island countries and areas, case notification rates considerably exceed the overall case notification rate in the Western Pacific Region of75 per 100000 population. This significant burden of TB, the emergence of multidrug resistant TB, and the increasing number of TB-HN cases in several countries continue to make TB control a ,priority in the Pacific. The First Pacific Stop TB Meeting in 200 I launched the Pacific Stop TB Initiative, which was the basis of the Pacific response to the TB crisis in the Region. National TB control plans were developed, aimed at reaching the 2005 TB targets of 70% case detection and 85% cure rates. At the Second Pacific Stop TB Meeting in 2004, countries and areas development plans to accelerate progress towards achieving the 2005 TB control targets. At the Third Pacific Stop TB Meeting, achievement of the 2005 Stop TB targets in the Pacific was acknowledged, and lessons learnt were used to guide the development of workplans for the 2010 goal of halving TB prevalence and mortality. The proposed Fourth Pacific Stop TB Meeting aims to review progress by Pacific island countries and areas in implementing recommendations to address, among others, laboratory strengthening, TB drug management and monitoring and evaluation. It will be necessary for countries supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria to review the five-year Global Fund grant workplans and identify technical assistance needs. At this meeting, Pacific partners will discuss issues specific to countries without Global Fund support, particularly strengthening the commitment to TB control. The meeting is co-organized with the Secretariat of the Pacific Community and will be hosted by the Queensland Mycobacterium Reference Laboratory of Australia, a WHO collaborating centre and a close partner in the Pacific TB Laboratory Initiative.
CONTENTS
I. INTRODUCTION ................................................................................................. . 1.1 Objectives ............................................................................................................... I 1.2 Participants ................................................................................ ................... .......... 2 1.3 Organization ... .......... ........... ...... ................................... .......................................... 2 2. PROCEEDINGS 2.1 2.2 2.3 2.4 2.5 .................................................................................................... 2
Current TB situation .............................................................. ................................. 2 Components of the Stop TB strategy ....... .......................... ............. ...... ....... .......... 3 Discussion on the Global Fund .............................................................................. 4 Roundtable discussion with partners ...... ..... ................. ................... ................... .... 6 Preparation of country plans for 2008-2009 ........................................................... 6
3. CONCLUSIONS AND RECOMMENDA TIONS ................................................. 7 3.1 Conclusions ........................... ....................... ................ ... ....... .......... ...................... 7 3.2 Recommendations ................................................................................................ II
ANNEXES: ANNEX I ANNEX 2 ANNEX 3 LIST OF PARTICIPANTS .................................................. TIMETABLE ....................................................................... 15 29
PRESENTATION OF FUTURE ACTIVITIES INVOLVING PATLAB PARTNERS ........................................................ 31
Key words: Tuberculosis - prevention and control! Pacific Islands
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I. INTRODUCTION
Following the declaration of a tuberculosis (TB) crisis in the Western Pacific Region, the World Health Organization, Secretariat of the Pacific Community (SPC) and their partners helped establish a strategic response to TB concerns in the Pacific. WHO and SPC, in collaboration with the United States Centres for Disease Control and Prevention (US CDC), coorganized a series of regional Stop TB meetings. The first Stop TB Meeting in the Pacific, which was held in 2000 in Noumea, New Caledonia, launched the Pacific Stop TB Initiative and DOTS strategy, which formed a basis for the Pacific response to the TB crisis in the Region. National five-year Stop TB plans were developed with the aim of reaching the 2005 TB targets of 70% case detection and 85% cure rates. At the second Stop TB Meeting in 2004 in Noumea, New Caledonia, countries reported on their progress and developed strategies to address constraints in the implementation of their TB control activities. The third Pacific Stop TB Meeting in 2006 in Noumea, New Caledonia, acknowledged the achievement of the 2005 Stop TB targets in the Pacific, and used lessons learnt to guide the development of workplans for achieving the 20 I 0 goal of reducing the TB prevalence and mortality by one half. Back-to-back with the Third Pacific Stop TB Meeting, a workshop was conducted to review and improve the TB estimates in the Pacific. This was followed by the joint meeting ofHIV and TB managers to address bottlenecks to implementation ofTB-HIV collaborative activities in the Pacific island countries and areas. Two years later, the fourth Pacific Stop TB Meeting was held in Brisbane, Australia, on 11-14 March 2008, to review the progress that Pacific island countries and areas made in implementing the recommendations to address, among others, laboratory strengthening, TB drug management, and monitoring and evaluation. It was also necessary for Global Fund-supported Pacific island countries and areas to review their five-year workplans and identify needs for technical assistance. The meeting was hosted by the Queensland Mycobacterium Reference Laboratory in Brisbane, Australia, a WHO collaborating centre and a close partner in the Pacific TB Laboratory (PaTLab) Initiative. 1.1.
Objectives (I) To review progress, identify constraints and develop approaches to accelerate the implementation of Stop TB workplans in Pacific island countries and areas with special attention to TB laboratory issues. (2) To make recommendations on workplan and management arrangements in countries implementing the new Global Fund TB grant based on lessons learnt from the previous grant. (3) To update participants on multidrug-resistant tuberculosis (MDR-TB) and the revised Regional Framework on TB-HIV Co-infection.
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(4) To review technical assistance needs in all Pacific island countries and areas, especially those without Global Fund grants, and identifY financing options to meet these needs. 1.2 Participants
There were 35 participants from 20 Pacific island countries and areas to the meeting. Technical advisers from the different international reference laboratories in Australia and New Zealand provided support to the meeting. Technical partners and donors also attended the meeting. The list of participants is in Annex 1.
1.3
Organization The presentations and discussions during the meeting focused on the following: (1) the current situation of the TB epidemic in the Region and in Pacific island countries and areas; (2) components of the Stop TB Strategy, in particular, MDR-TB, TB-HlV co-infection, TB in children, recording and reporting, contact investigation, International Standards of Care (ISTC), drug management, laboratory strengthening and external quality assessment; and (3) the Global Fund -lessons learnt, grant closing and evaluation of Round 2.
The meeting also included roundtable discussions with partners and the preparation of country workplans for 2008-2009. The detailed timetable is in Annex 2. All presentations during the meeting can be downloaded from the Stop TB website, http://stoptb.wpro.who.int.
2.
PROCEEDINGS
2.1
Current TB situation
TB is a major public health problem in the Western Pacific Region, including the Pacific island countries and areas. In 2006, there were an estimated 1.3 million new TB cases and 295 000 TB deaths in the Region. With an estimated 1600 new TB cases every year, the burden of TB in the 20 Pacific island countries and areas, excluding Papua New Guinea, is relatively small. However, in some of the Pacific island countries and areas, e.g. Kiribati, the Marshall Islands, the Federated States of Micronesia and Solomon Islands, case-notification rates considerably exceed the overall case notification rate in the Region of7 5 per 100 000 population, which makes TB control a priority in these countries (See Figure I). In the past few years, multidrug-resistant TB has emerged in several Pacific island countries and areas, and surveillance of HlV among TB patients has revealed a slowly increasing number of TB-HlV cases.
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Figure 1. TB case notification rates in the Pacific island countries and areas, 2006 Kiribati Marshall Islands
PNG
Nauru Tuvalu FSM Solomon Islands Palau CI\MI Vanuatu TOTAl Wallis & Futuna Guam ~ French Polynesia ~ New Caledonia l1lil1li" Tonga Samoa l1li Fiji. American Samoa _ Cook Islands -1'-'---+---+--+---+--+---"--+--1---1
o
50
100
150
200
250
300
350
400
450
ratll per 100,000 pop
Source: SPC, 2008 (presented during the meeting) Substantial progress has been achieved in the Western Pacific Region, including in the Pacific island countries and areas. The Region, overall, is the first and only WHO Region that has achieved the global TB control targets of 70% case detection and 85% treatment success rates. The Pacific island countries and areas, overall, have achieved the TB control targets, although the Melanesian countries have yet to achieve the 70% case detection target. 2.2 Components of the Stop TB Strategy
One of the main concerns discussed during the meeting was the increasing prevalence of MDR-TB in the Pacific island countries and areas. So far, eight confirmed cases have been reported by five countries in the Pacific. After a brief overview on the global and regional situations pertaining to MDR-TB and extensively drug-resistant tuberculosis (XDR-TB), the discussions focused on the Pacific situation. The MDR-TB sessions reviewed the MDR-TB response so far and oriented the participants on the role of the Green Light Committee, which provides access to high-quality second-line drugs at concessionary prices for treating emerging MDR-TB cases in the Pacific. Samoa shared its experience with MDR-TB to demonstrate how an MDR-TB case can be managed in the Pacific through strong coordination at the country level and with support from international partners. Infection control, which is an important part of the response to MDR-TB, was discussed in detail through a separate presentation by the US CDC and a presentation on response in the context of Samoa's MDR-TB case. The presentations highlighted why infection control is important, how it is implemented, and what the issues are in its implementation. Laboratory quality has been an important issue in the Pacific context. Given the low workload of laboratories and the limited capacity of laboratories beyond provision of microscopy services, there is a need to maintain access to quality-assured diagnosis, not only for regular TB, but also for MDR-TB. This continues to be effectively addressed by the Pacific TB Laboratory Initiative (PaTLab). The Pacific Stop TB meetings, which have always featured laboratory
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quality as an agenda item, have provided a forum to discuss PaTLab and to plan for future activities involving PaTLab partners and the countries supported by the network (see attached presentation on PaTLab in Annex 3). This year's meeting added important discussions on the future of diagnosis in the Pacific, including discussions not only on building capacity on culture and drug susceptibility testing (DST) in the Pacific, but also adopting new tools for diagnosis. The other discussions focused on aspects of the Strategic Plan to Stop TB in the Western Pacific 2006-20 I 0 and Stop TB Strategy that are relevant to the Pacific, including recording and reporting, TB in children, drug supply management and International Standards of Care, contact investigation and the link between TB and diabetes in the Pacific. These discussions were meant to highlight the issues and to draw out ways to address these issues at the Pacific regional level and in the countries and areas. The meeting underscored the importance of setting a tirneframe for the harmonization of recording and reporting requirements of the technical partners. Participants had serious discussions on ensuring the uninterrupted supply of quality-assured drugs, highlighting the role of the Global Drug Facility (GDF). However, long-term solutions on issues concerning drug supply management in the Pacific, overall, were not addressed. The presentation on TB and diabetes drew significant interest, as the issue had not been brought up before at this level. This presentation clearly highlighted the need to increase the attention given to the link between TB and diabetes in regional and national plans. 2.3 Discussion on the Global Fund
In the past five years, 10 Pacific island countries have received Global Fund support through a Round 2 grant to implement their DOTS programmes, with satisfactory results overall. The Global Fund has become a significant source of financing for the Pacific. As the Round 2 project winds down, a Round 7 grant will soon provide an additional US$ I I .57 miIIion for I I I countries in the Pacific .. The presentation highlighted the lessons learnt from Round 2 implementation, which hopefully will feed into more detailed planning for the Round 7-supported workplans. The presentation also included discussions on the process for Round 2 grant closure to let countries know what will be required of them. Before the end of Round 2, WHO wiII coordinate a an evaluation of the implementation of the Global Fund supported activities in the PICs The participants were oriented on the process and objectives of the evaluation. Dr Anastasios Constantinos wiII provide technical assistance for the review. In addition, the session on the Global Fund oriented the participants on the process and expectations of the Global Fund Round 7 grant, which is expected to provide funding for TB activities in I I countries in the Pacific. 2.4 Roundtable discussion with partners
A roundtable discussion among technical partners and donors was chaired by Dr Jim Tulloch, Principal Health Adviser, Australian Agency for International Development (AusAID). Cook Islands, Federated States of Micronesia, Kiribati, Nauru, Niue, Palau, Republic of Marshall Islands, Samoa, Tonga, Tuvalu, Vanuatu I
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A presentation by Dr Pieter van Maaren, Regional Adviser for Tuberculosis, WHO Regional Office for the Western Pacific, provided the background and the stimulus for the discussion. Dr van Maaren gave an overview of technical and financial support to Pacific island countries from the perspective of WHO and concluded the following: (1) There is limited human resource capacity to meet the technical assistance needs of the Region, including the Pacific island countries and areas. (2) Despite the assistance of the Global Fund, there are serious gaps in funding and technical assistance, especially in Fiji and Solomon Islands. (3) There is a need to strengthen the coordination of regional and intercountry technical assistance, including for data management, PaTLab and MDR-TB response. Following the presentation, each of the partners represented at the meeting provided an overview of its activities, the support it provides to the Pacific island countries and areas, and other issues. 2.4.1 United States Centres for Disease Control and Prevention (US CDC)
Dr Kashef ljaz described how the US CDC supports the six US-affiliated Pacific island countries in the areas of data management and surveiJIance; laboratory support; technical backstopping; and collaboration with the Australian Respiratory Council (ARC) on TB nursing issues. 2.4.2 Secretariat of the Pacific Community (SPC)
Dr Janet O'Connor described the limited technical assistance resources ofSPC, consisting of only three fun-time technical staff and thinly stretched financial resources. Current funding comes mostly from SPC's own resources, including a grant from New Zealand Agency for International Development (NZAID). In addition to providing technical assistance to countries in the Pacific, SPC is involved in supporting an AusAID project in Kiribati.
2.4.3
The Pacific TB Laboratory Initiative (PaTLab)
PaTLab, which is an initiative coordinated by WHO in partnership with SPC and US CDC, has been crucial in strengthening laboratory quality in the Pacific island countries. Mr David Dawson, PaTLab Coordinator, emphasized the need for financial support for the supranational reference laboratories to extend technical support to laboratories in the Pacific, as wen as other countries in the Western Pacific Region. 2.4.5 Institute of Medical and Veterinary Sciences (IMVS), Adelaide, Australia and Queensland Mycobacterium Reference Laboratory (QMRL), Brisbane, Australia IMVS and QMRL have been providing technical support to several countries in the Pacific, South-East Asia and Western Pacific Regions. With the increasingly limited technical resources in the Pacific and throughout the Western Pacific Region, IMVS and QMRL will continue to playa crucial role in providing technical assistance, particularly in the area of laboratory capacity and quality. However, Dr Ivan Bastian, Head ofIMVS, highlighted the lack of financial support for the technical assistance. He estimated that technical assistance costs IMVS around US$ 125 000 annually, which, apart from minor funding from WHO, is largely sourced from IMVS funds. Dr Bastian indicated that obtaining funding support from the Global Fund grants was difficult.
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2.4.6
Queensland Health
Queensland Health is currently not involved in the provision of technical assistance in the Pacific. Dr Constantinos, TB specialist at Queensland Health, suggested the Australian Council of State TB Controllers as a possible source of fmancial and technical support to Pacific island countries. 2.4.7 The Global Fund Secretariat
Ms Patricia Kehoe, portfolio manager of the Global Fund Round 7 multi country grant, indicated that the Global Fund considers it the responsibility of countries to include provisions for technical assistance. However, the experience in general is that most Global Fund grants include few provisions to finance external technical assistance, as was confirmed by several participants, including Dr Jim Tulloch, who related his experiences as a WHO staff member. In general, countries are reluctant to use their Global Fund grants for external technical assistance that is perceived by them as expensive. WHO has repeatedly brought this to the attention of the Global Fund and its Board members, but so far, the Global Fund Board has not addressed this issue. In fact, it was reiterated by participants that the Global Fund has not done enough to advocate for adequately financing technical assistance provided by technical partners. Dr Tulloch mentioned that he will request the Australian Government to present this issue to the Global Fund Board. 2.4.8 Australian Respiratory Council (ARC)
Ms Amanda Christensen provided a brief overview of ARC's activities in the Pacific. Most of the support concerns nursing activities, community-level TB activities and education, some of which are conducted in collaboration with CDC. Most of the funding for the activities comes from ARC's own resources. 2.4.9 Australian Agency for International Development (AusAID)
Dr Tulloch explained the current thinking of AusAID in development cooperation. AusAID is moving away from eannarked funding, e.g. for disease control programmes, towards support for health systems and un-eannarked funding. However, AusAID still prioritizes HIV/ AIDS and malaria. Dr Tulloch also mentioned that AusAID still has an interest in supporting TB technical assistance, as long as it is related to MDR-TB and TB-HIV co-infection. He stressed that WHO should do better advocacy to ensure AusAID support for its work. As most developed countries, Australia provides significant funding to the Global Fund. AusAID bas realized that technical agencies such as WHO are instrumental for Global Fund proposal preparation and implementation. WHO is preparing a proposal for funding in support of Global Fund-related technical assistance.
Dr Tulloch fmally stated that AusAID should be looking into protecting the investment made by Australian institutions in development aid. The roundtable discussion concluded by calling for further dialogue between partners and technical agencies to ensure the effective delivery of necessary technical assistance. 2.5 Preparation of countrv plans for 2008-2009
All countries prepared country plans in line with the Strategic Plan to Stop TB in the Western Pacific 2006-2010, with specific focus on the priorities discussed during the meeting.
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3. CONCLUSIONS AND RECOMMENDATIONS
3.1 3.1.1
Conclusions General
(I) Overall, progress was achieved in the implementation of the national TB control plans in line with the Strategic Plan to Stop TB in the Western Pacific 2006-2010. (2) Substantial technical support was provided by SPC, US CDC, WHO and other partners (e.g. Australian Respiratory Council and Burnett Centre) in the implementation of the national TB control plans. Financing for TB control in the Pacific was provided through national government budgets, donor support from the Global Fund, AusAID and NZAID, and technical partners' own budgets. (3) Support for strengthening capacity and quality oflaboratory services was provided through the Pacific TB Laboratory (PaTLab) Initiative by the Pacific TB Reference Laboratories (PTRLs) in Adelaide and Brisbane, Australia; Wellington, New Zealand; and Hawaii, USA. (4) Despite increasing support from the Global Fund in the Pacific, the meeting noted some major gaps in funding and technical assistance, including immediate gaps in Fiji and Solomon Islands. 3. I .2 International Standards of TB Care (ISTC)
(1) The Pacific island countries and areas welcome the International Standards of TB Care as a useful tool for promoting high-quality TB services in the Pacific islands, especially for nonNational Tuberculosis Programme health providers who manage TB patients in some settings. 3. 1.3 Laboratory
(I) Participants acknowledged the role of the PaTLab Initiative in continuing to provide essential services to the TB laboratories in the Pacific through technical training and advice, external quality assessment, culture and drug susceptibility testing. Participants welcome the inclusion of the Diagnostic Laboratory Services, Hawaii, into the PaTLab mechanism (replacing Microbial Diseases Laboratory, California) as the provider of culture and DST to USAffiliated Pacific Islands (USAPI). Participants thanked the Microbial Diseases Laboratory for its support to USAPI.
It was reported that every Pacific island country with a TB laboratory now has TB (2) technicians with specific training in sputum smear microscopy.
(3) Building capacity to perform quality-assured culture in several Pacific island countries has been a significant challenge. Routine culture is generally available only to US-affiliated and francophone Pacific island countries and areas. PJ Twomey Hospital in Fiji offers a simple culture method best suited for smear-positive samples. If routine standard culture was applied in other Pacific island countries, the number of lab-conftnned TB cases could be increased by up to 100%. An important additional benefit of culture is that it provides an isolate for DST.
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(4) Participants recognized that culture is more technically demanding than microscopy, requiring purpose-built facilities, more expensive equipment and higher recurrent operational costs. TB culture should not be contemplated unless there already is a quality-assured microscopy service performing at a satisfactory standard. The implementation of external quality assessment (EQA) for sputum microscopy, which (5) is achieved through on-site evaluations, panel testing and blinded slide rechecking - the most powerful tool for EQA, remains a critical component of ensuring high-quality laboratories in the Pacific. Collaboration among the PTRLs has resulted in panel tests being provided to the majority of Pacific island countries. The implementation of blind slide rechecking in several countries in the southern Pacific, (6) and the efforts of PTRLs to provide panel tests to a majority of the Pacific island countries, are significant achievements in the performance of EQA through PaTLab. It was acknowledged that the collection of Quarterly Workload Reports will assist PTRLs in maintaining the costeffectiveness of blind slide rechecking. (7) Genotyping of Mycobacterium tuberculosis (MTB) isolates from USAPI revealed that around 75% of isolates belonged to various clusters between 2004 and 2007. Epidemiological investigations for clustered cases will inform the contribution of such testing to TB control in USAPI. 3.1.4 Multidrug resistant TB
(I) PaTLab provides well-organized laboratory technical support to accurately detect drugresistant TB cases. A mechanism has been put in place to provide clinical advice on case management of drug resistant TB, but this has yet to be enhanced and formally linked to affiliated reference laboratories.
(2) Available data indicate low levels of drug resistance in the southern Pacific. Higher levels exist in Micronesia due to population movements and other socioeconomic factors. Occasional cases ofMDR-TB have been identified in the Pacific. (3) Effective management of drug-resistant TB cases requires accurate and reliable culture and DST and an intensive multidisciplinary approach to case management to achieve treatment success. (4) A fast-track application to the Green Light Committee was developed for the Pacific islands to ensure access to quality-assured second-line drugs. However, ensuring the timely procurement and delivery of these drugs has been a challenge. (5) Molecular technologies such as Hain Lifescience Genotype® MTBDRplus are under evaluation as potential tools for resource-limited settings. It is noted that such tests call for appropriate laboratory facilities and trained technicians. These new diagnostic tools, however, require additional evaluation before application in TB laboratories in Pacific island countries. 3.1.5 Infection control
(1) Infection control is an integral part ofTB control, and in particular to the MDR-TB response in countries.
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3.1.6
Drug management
(1) Ensuring uninterrupted supply of anti-TB drugs in several Pacific island countries remains a big challenge. In the past year, several countries experienced drug shortages that, in most instances, were corrected through emergency drug orders. (2) Participants acknowledged the potential role of the Global Drug Facility in the Pacific region. Several countries, namely Samoa, the Federated States Micronesia, Tuvalu and Solomon Islands, are now using drugs procured through the GDF mechanism. 3.1. 7 TB in children
(1) Participants recognized the difficulties in diagnosing and reporting TB in children. The WHO Guidance to National TB Programmes for the Management of TB in Children has to yet to be adopted and implemented in the Pacific.
In most countries, active case finding is implemented among household contacts of smear(2) positive index TB cases. 3.1. 8 Recording and Reporting
The participants acknowledged the need to harmonize the recording and reporting (1) requirements of the three technical partners - SPC, WHO and US CDC - to help streamline the reporting and recording mechanism. (2) There is a wealth of data that is relevant to TB control, which, if optimally used, can be very useful for informing programme implementation. (3) Participants recognized the need to report to WHO, as this will enable the monitoring of global progress towards the Millennium Development Goals. 3.1.9 TB-HN co-infection
The participants recognized the low level of HN in TB patients in the Pacific island (1) countries and areas. Surveillance efforts have been stepped up over the past two years, but only a few co-infected individuals have been identified, mostly in Kiribati. (2) In general, the provider-initiated testing and counselling policy is not in place. TB patients are referred to HN testing and counselling centres for HN testing, where these are available, with limited number of patients actually tested. 3. J.l 0 Contact investigation
(1) Contact investigation is an important component of TB programmes in the Pacific. Contact investigations are implemented in most Pacific island countries and areas through different approaches, but with a focus on screening household contacts of smear-positive TB cases. Training has been provided by international partners. The use ofPPD testing to screen eligible individuals for isoniazid preventive therapy (IPT) (2) needs to be further evaluated before a policy applicable to the Pacific setting can be recommended.
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3.1. 11
TB and diabetes
(1) Participants noted with concern the indication from the Commonwealth ofthe Northern Mariana Islands and other Pacific countries that diabetes is a common co-morbid condition among TB patients in the Pacific. (2) Considering the high prevalence of diabetes mellitus in the Pacific, this is an area that should be looked at closely as it may have implications on case management of patients due to drug interactions of oral hypoglycaemic agents and anti-TB drugs, and may impact TB control efforts because of the increased likelihood ofTB among people with diabetes. 3.1.12 Global Fund
(I) The participants acknowledged the strong support provided by the Global Fund in the last five years through the Round 2 multicountry grant to 10 Pacific island countries. The Round 2 grant is moving into the "grant closure" stage, which is a normal part of the Global Fund grant cycle. (2) The participants recognized several lessons learnt in the implementation of the Global Fund grant in the last five years, including the need for teclmical assistance to ensure effective implementation of grants in the countries and areas. (3) The participants anticipated an increase in Global Fund support through a Round 7 multi country Pacific grant, which is currently being negotiated with the Global Fund. 3.1.13 Partners meeting
(I) The participants of the roundtable discussion recognized that teclmical assistance is crucial to achieving good progress in TB control in the Pacific. The needs have been increasing following the implementation of the new Stop TB Strategy and the emergence of drug-resistant TB in the Pacific. (2) The partners acknowledged the limited capacity, both in human and fmancial resources, of the teclmical partners, including SPC, US CDC and WHO, to meet the increasing demand for technical assistance. (3) Despite increasing support from the Global Fund in the Pacific, the meeting noted some major gaps in funding and teclmical assistance, including immediate gaps in Fiji and Solomon Islands. (4) The partners further acknowledged that the PTRLs contribute substantially to TB control in the Pacific, yet these institutions are faced with severe resource constraints to sustain their services. (5) The increased needs for teclmical assistance and the complexity of approaches, e.g. data management, laboratory strengthening and MDR-TB response, demand further strengthening of coordination among the teclmical partners.
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3.2 3.2.1
Recommendations International Standards ofTB Care (ISTC)
(I) Countries and areas are encouraged to promote the adoption of the International Standards ofTB Care among non-programme providers, and use it as a tool for training health providers and to guide activities of professional societies where relevant. (2) National TB programmes should ensure that all TB clinicians from the public and private sector adopt and adhere to the ISTC in the management of all TB patients. (3) Partners should provide technical support to countries and areas to promote adoption of the ISTC. 3.2.2 Laboratory
(I) Quality-assured sputnm-smear microscopy performed in local laboratories should be retained as the primary means for diagnosing TB in Pacific island countries. (2) National TB programmes and laboratories should maintain regular communication with respective PTRLs in order to obtain maximum benefits through PaTLab. (3) National TB programmes should take a proactive role in EQA, ensuring that panel tests and blinded rechecking exercises are completed on schedule and that corrective actions are implemented. (4) USAPI laboratories should send shipments of samples each fortnight to provide the maximum number of diagnoses. Where delay is unavoidable, samples should be refrigerated. (5) Countries in the southern Pacific should request assistance from partner PTRLs in investigating treatment failures, relapses and other patients considered to be at a high-risk for MDR-TB. (6) Laboratories and national TB programmes should collaborate in compiling laboratory workload statistics on a quarterly basis with copies provided to the respective PTRL. 3.2.3 Multidrug-resistant TB
(I) Management ofMDR-TB cases should be accompanied by efforts to strengthen the TB programmes, prevent misuse of second-line anti-TB drugs particularly floroquinolones, and monitor for any drug resistance. (2) Appropriate legislation or other regulatory mechanisms should be put in place to avoid the misuse of second-line anti-TB drugs, including for infections other than tuberculosis, in order to prevent further amplification of drug resistance in the Pacific. (3 ) Technical partners should support the development of a framework of response to drugresistant TB in the Pacific that will link the three critical aspects of case management of drugresistant TB, i.e. laboratory services, technicaVclinical support for case management, and the timely provision of second-line drugs.
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(4) Drug susceptibility testing should be retained as part of the routine work-up of all cases in USAPI and the francophone Pacific island countries and areas. Treatment-failure cases, relapse cases, contacts ofMDR-TB cases that develop active disease, and other patients considered at risk of MDR-TB in the southern Pacific should be tested in Adelaide or Brisbane PTRLs. (5) WHO should work with the Green Light Committee to facilitate timely approvals of applications and delivery of drugs in the Pacific island countries and areas. 3.2.4 Infection control
(I) Countries and areas should implement appropriate infection control measures according to international guidelines; in particular, administrative measures are likely to be the most relevant infection control method in the Pacific settings. (2) Such administrative measures should include a documented infection control plan to address issues such as suspect case identifications, placement of patients in outpatient and inpatient settings, cough etiquette, work flow design, and referral patterns. Administrative support should extend to the education of laboratory workers, clinical health care workers and the community, and to the facilitation of communication between clinical environments, the national TB programme and the laboratory. 3.2.5 Drug management
(1) Pacific island countries and areas should consider using GOF to ensure the supply of quality-assured TB drugs, to standardize the TB treatment regimen, and to simplifY the monitoring and management of drugs.
(2) Countries and areas should monitor closely their TB drug stock at national and peripheral levels, accurately forecasting the requirements and initiating the procurement process in a timely manner, considering the lead times involved. (3) Countries and areas should ensure the availability of funding, as much as possible from the government budgets, for anti-TB drugs as an indication of commitment to TB control. 3.2.6 TB in children
(I) Countries are urged to adopt the WHO Guidance to National TB Programmes for the Management ofTB in Children. (2) Isoniazid preventive therapy (JPT) should be provided to all asymptomatic children under five years old who are household contacts of smear-positive TB cases. If the index case is proven to have MDR-TB, expert opinion on management of household contacts can be obtained via the PTRL network. 3.2.7 Recording and reporting
(I) The technical agencies should push the harmonization process, ensuring that all required data fields are included in a single set of recording and reporting tools. This exercise should be completed as soon as possible and no later than the end of 2009. (2) Countries should continue to complete and submit required reports to the three technical agencies, especially WHO annual data collection forms, in accordance with commitments by Member States to the World Health Assembly.
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(3) Partners should provide countries with technical support to strengthen their capacity to analyse and utilize data for improving their TB programmes, including enabling the measurement of performance ofTB programmes overtime. 3.2.8 TB-HIV co-infection
(I) Pacific island countries should continue surveillance efforts in· order to identify TB-HIV co-infections and to provide an alert mechanism to all countries. Some countries, Kiribati in particular, should consider introducing a provider-initiated testing and counselling policy.
(2) The participants agree that the ultimate goal is for HIV testing to become available to all TB cases. In addition, countries should ensure that improved surveillance and collaboration between TB and HIV programmes should lead to: (a) the systematic screening for TB in people living with HIV; (b) the introduction of isoniazid preventive therapy (JPT) and co-trimoxazole preventive therapy (CPT); (c) early access to care and treatment, and (d) the update of HIV and TB information systems to capture essential TBHIV information. 3.2.9 Contact investigation
(1) Countries should prioritize detection of new TB cases among household contacts of smearpositive TB cases. (2) Contact investigation should not be conducted if it impedes on the delivery of quality DOTS services and should commence only after assessing the readiness of the national TB programmes and after appropriate training. (3) Countries that have implemented PPD testing among adults should analyse the data to provide guidance on the rational use of PPD in adults in the Pacific setting. (4) SPC, in consultation with WHO and US CDC, should review existing guidelines and practices for contact investigations in countries in the South Pacific and develop, in line with scientific practice, guidelines that are appropriate for these countries. 3.2. \0 TB and diabetes
(I) Technical agencies should support research in the Pacific to gather more information on the association between diabetes and TB in order to provide evidence-based recommendations. (2) Potential areas for further research include the role of intensified case finding for TB among diabetic patients, screening for diabetes among TB patients, and isoniazid preventive treatment for people living with diabetes. 3.2.11 Global Fund
(I) To ensure the smooth grant closure process, the 10 countries that received the Global Fund Round 2 grant should accelerate the implementation of their Global Fund-supported activities and submit fmancial and programmatic reports on time. (2) To ensure timely access to Round 7 funding, recipient countries of the new Global Fund grant should become familiar with the Round 7 work plan, integrate work plan activities into the national TB work plans by July 2008 and ensure the timely processing of the requirements for the sub recipient negotiations, as directed by the Principal Recipient of the grant.
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(3) Based on a new requirement of the Global Fund, countries should undertake an assessment of their monitoring-and-evaluation system and develop a plan to strengthen it, using the monitoring-and-evaluation system strengthening tool developed by the Global Fund, through a country-level workshop. (4) Countries should identify potential bottlenecks to Global Fund implementation early, identify technical assistance needs, and request for technical assistance from partners in a timely manner. 3.2.12 Partners meeting
(I) Donors and other partners are urged to increase their fmancial support to address the shortfall in funding for TB control in the Pacific, including the immediate funding needs in Fiji and Solomon Islands, and in funding for technical assistance. (2) The technical partners should increase their efforts to meet the increasing demand for technical assistance. This includes building technical capacity in the Pacific island countries and Areas. (3) Partners urged the Australian Government to speak to the Global Fund Board about their concern of the lack of funding for technical assistance in Global Fund grants and to propose options for funding for technical assistance outside the Global Fund grants. (4) Technical partners should strengthen coordination of technical assistance, including timely sharing of information on activities, harmonization of approaches and implementation of the Pacific regional responses, e.g. PaTLab, MDR-TB response, regional procurement mechanisms. (5) Donors are requested to support the PTRLs to sustain their crucial contribution to the regional and global TB control.
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ANNEXl
LIST OF PARTICIPANTS
L PARTICIPANTS AMERICAN SAMOA MlI Faraitoafa Utu Territorial HIV/AIDS Programme Coordinator Department of Health American Samoa Government Pago Pago 96799 Tel. No,: (684) 258 9239 Fax No,: (684) 6337561 E-mail: farautu@yahoo.com MlI Edna Mata Potoru Public Health Nurse Ministry of Health Rarotonga Tel. No.: (682) 29110 Fax No.: (682) 29100 E-mail: e.potoru@health.gov.ck Dr Sakiusa MainawaIa1a Tuberculosis Control Officer for Western Fiji Lautoka Hospital Lautoka Tel. No,: (679) 6660899 Fax No.: (679) 6665423 E-mail: Ms Maopa Raikabu1a Laboratory Technician P. J. Twomey Hospital T amavua, Private Mail Bag Suva Tel No.: (679) 332 1066 Fax No.: (679) 332 1364 E-mail: mratuvuki@yahoo.com
COOK ISLANDS
FIJI
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FRENCH POLYNESIA
Dr Philippe Biarez Head of Health Trainings Hospital de Moorea BP 635 Maharepa Moorea Tel No.: (689) 79 1959; 55 22 22 Fax No.: (689) 56 32 75 E-mail: philippe.biarez@sante.gov.pf Dr Marc Levy Microbiologist Laboratoire Biologie Centre Hospitalier de Polynesie Francaise BP 1640 - 98 713 Papeete Tel. No.: (689) 46 62 27 E-mail: marc.IeVV@cht.pf
GUAM
Dr Cecilia Teresa T. Arciaga Communicable Disease Coordinator, Supervisor Department of Public Health and Social Services 123 Chalan Kareta Mangilao 96913-6304 TeI.No.: (671) 735-7170 Fax No.: (671) 735-7158 E-mail: cecilia.arciaga@dphss.guam.gov MsLeaNisay Microbiologist Department of Public Health and Social Services 123 Chalan Kareta Mangilao 96913-6304 Tel. No.: (671) 735-7170 Fax No.: (671) 7357158 E-mail: lea.nisay@dphss.guam.gov
KIRIBATI
Dr Airam Metai Director, Public Health Ministry of Health and Medical Services Nawerewe, Tarawa Tel. No.: (686) 28100 Fax no: (686) 28152 E-mail: airammetai@Vahoo.com
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Mr Tekaibeti Tarataake Medical Laboratory Technician Ministly of Health and Medical Services P. o. Box 268 ~avverevvere, Taravva Tel. ~o.: (686) 81339 Fax ~o.: (686) 81266 or 81201 Ms Bereka Reiher TB Programme Coordinator Ministly of Health and Medical Services POBox 268 Bikenibeu (~avverevvere) Tel. ~o.: (686) 28100 Ext 251 Fax ~o.: (686) 28152 Email address:berekaI958@Yahoo.com MARIANA ISLANDS, COMMONWEALm OF THE NORTHERN Dr Richard Brostrom Medical Director Division of Public Health Commonvvealth Health Center Box 500409 Saioan MP 96950 Tel. ~o.: (670) 234-8950 Fax ~o.: (670) 236-8700 E-mail: richard.brostrom@gmail.com Mr Paul Lalita Laboratory Manager Majuro Hospital Delap, Majuro Tel. ~o. 011 6926253355 ext. 2377 Fax ~o.: 011 6926254543 E-mail: paullalita@Vahoo.com Dr Godfrey Waidubu Staff Physician Majuro Hospital Ministly of Health Majuro 96960 Tel. ~o.: (692) 625 3355/455 5605 Fax ~o.: (692) 625 4375 E-mail: godfrevvvdbu@Vahoo.com.au
MARSHALL ISLANDS, REPUBLIC OF
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MICRONESIA, FEDERATED STATES OF
Dr Mayleen Jack Ekiek National TBIHD Programme Manager P. O. BoxPS-70 Palikir Pohnpei96941 Tel. No.: (691) 320 1203 Fax No.: (691) 320 5263 E-mail: mekiek@fsmhealth.fin Mr Kasian Otoko Medical Laboratory Technician Chuuk State Hospital Moen, Chuuk 96942 Tel. No.: (691) 330 2216/2217 Fax No.: (691) 330 2320 E-mail: kjoto61@hotmail.com
NAURU
Ms Isabella Amwano TB Programme Manager Ministry of Health Government Office Yaren Tel No.: 444 3883 ext. 116 Fax No.: E-mail: Sithu.WinTin@Nauru.gov.nr sithu@cenpac.net.nr Ms Elizabeth Detabene Ward Manager Ministry of Health Government Office Yaren Tel No.: 444 3133/444 3805 Fax no.: E-mail: queda26@gmail.com
NEW CALEDONIA
Dr Bernard Ronchon· Director Agence sanitaire et sociale de la Nouvelle-Caledonie Noumea Tel. No.: 25.07.60, Fax No.: 25.07.64 E-mail: bemard.rouchon@ass.nc
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NIUE
Ms MinemaIigi Hetutu Pulu Maternal and Child Health Nurse Health Department P.O.Box 179 Alofi Tel. No. 683 4105 Fax No.: 683 4265 E-mail:phcnurse@mail.gc Ms Antonnette Merur Nursing Unit Supervisor MedicaI/Pediatric Ward Ministry of Health P. O. Box 6027 Koror96940 Tel No. (680) 488-6283 Fax No.: (680) 488-2552 ext. 11 E-mail: amerur@palau-health.net Ms Salustia Mira TBNurse Ministry of Health P. O. Box 6027 Hospital Road Koror Tel. No.: (680) 488-2450 Fax No.: s mira@palau-health.net
PALAU, REPUBLIC OF
PAPUA NEW GUINEA
Dr Joseph Bana-Koiri Senior Medical Officer, TB Port Moresby General Hospital Private Mail Bag Boroko,NCD Tel. No.: (675) 324-8205/82105 Fax No.: (675) 325-0342 E-mail: Mr Saul Pembu Laboratory Manager Central Public Health Laboratories Port Moresby General Hospital Private Mail Bag Boroko, NeD Tel. No.: (675) 324-8331 Fax No.: (675) 325-6342 E-mail:
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SAMOA
Dr Saine Va'ai Senior Medical Officer - Public Health Ministry of Health Private Box Motootua Tel No.: Fax No.: (685) 21106 E-mail: SaineV@health.gov.ws Ms Serati Moa Registered Nurse on National TB Programme Samoa National Health Services Ministry of Health Apia Tel. No. (685) 21212 ext 693 Fax No.: E-mail: MaatasesaS@health.gov.ws
SOLOMON ISLANDS
Mr Noelltogo National TB Coordinator Disease Prevention and Control Unit Ministry of Health and Medical Services P. O. Box 349 Honiara Tel. No.: (677) 20930 Fax No.: (677) 20085 E-mail: nitogo@solomon.com.sb Mr Paul Mauruwai Senior Laboratory Technologist Baula Hospital Ministry of Health and Medical Services Isabel Province Tel. No.: (677) 35211 Fax No.: (677) 35068 E-mail:
TOKELAU
Ms Malae Fepuleai Nurse Manager Taupu1ega ofNukunonu Tokelau Tel. No.: (685) 29143 Fax No.: (685) 29143 E-mail:
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TONGA
Dr Malakai 'Ake Chief Medical Officer Public Health Ministry of Public Health P. O. Box 59 Nuku'alofa Tel. No.: (676) 23-200 Fax No.: (676) 24-291 E-mail: drmalakaiake@hotmail.com Ms Mary Fakahau Senior Medical Scientist Ministry of Health P. O. Box 59 Nuku'alofa Tel. No.: (676) 23-200 Fax No.: (676) 24-291 E-mail:
TUVALU
Dr Nese Ituaso-CODway Chief, Public Health Princess Margaret Hospital Ministry of Health Funafuti Tel. No.: (688) 20765 ext! 1291 Fax No.: (688) 20832 E-mail: nituaso@Vahoo.com;cph@tuvalu.tv
VANUATU
Mr Markleen Tagaro Acting National TBlLeprosy Control Coordinator Public Health Ministry of Health Private Mail Bag 9009 Port Vila Tel. No.: (678) 22512 Fax No.: (678) 25438 E-mail: mtagaro@vanuatu.gov.vu
Mr Raymond SeuIe National Tuberculosis Laboratory Officer Vila Central Hospital Private Mail Bag 9013 Port Vila Tel. No: (678) 22100 ext. 60 Fax No.: (678) 26721 E-tnail: rseule@vanuatu.gov.vu
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WALLIS AND FUTUNA
Dr Laurent Morisse Executive Officer, COIIIPrehensive General Medicine Sia Hospital Wallis Tel. No.: (681) 72 0700 Fax No.: (681) 72 11 79 E-mail: laurent-morisse@adswf.org
2. TEMPORARY ADVISERS Dr Ivan Bastian Clinical Microbiology Consultant Institute of Medical & Veterinary Science PO Box 14, Rundle Mall Adelaide, South Australia 5000 Tel. No.: 61 88222-3291 Fax No.: 61 882223453 E-mail: ivan.bastian@imvs.sa.gov.au Ms Robyn Carter
Chief Scientist Queensland Mycobacterium Reference Laboratory Block 7 Royal Brisbane and Women's Hospital Campus Herston, Oueensland 4029 Australia Tel. No.: 61 7 3636 0032 Fax No.: 61 73636 1336 E-mail: RobvnCarter@health.qld.gov.au Dr Chris Coulter Director Queensland Mycobaterium Reference Laboratory Pathology Queensland Central Laboratory Floor 5, Block 7 Royal Brisbane and Women's Hospital Herston Road Herston, Oueensland 4029 Australia Tel No.: 61731394344 Fax No.: 61731394553 E-mail: ChrisCoulter@health.qld.gov.au
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Mr David Dawson Laboratory consultant 67 Biggs Avenue Beachmere, Queensland Australia Tel. no.: 61 754968204 Fax no. E-mail: deedaw@bigpond.net.au Mr John Ernest EUiot Director Pacific Paramedical Training Centre P.O. Box 7013 Wellington New Zealand Tel. No.: 64-4389-6294 Fax No. 64-4-389-6295 E-mail: Illltc@olltc.org.nz Dr Richard Stapledon Royal Adelaide Hospital Chest Clinic 275 North Terrace Adelaide Australia Tel. No.: 61 882225435 Fax No.: 61 882225957 Email: richard.staIl1edon@health.sa.gov.au
3. REPRESENTATIVES OF PARTNER AGENCIES
AUSTRALIAN RESPIRATORY COUNCIL (ARC)
Ms Amanda Christensen Director Australian Respiratory Council Level 4, 16 O'Connell Street Sydney NSW 2000 GPO Box 102 Sydney NSW 2001 Australia Tel. No.: (612) 92233144 Fax No.: (612) 92233044 E-mail: arc@thearc.org.au
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Ms Pamela Banner Australian Respiratory Council Level 4, 16 O'Connell Street Sydney NSW 2000 GPO Box 102 Sydney NSW 2001 Australia Tel. No.: (612) 92233144 Fax No.: (612) 92233044
AUSTRALIAN AGENCY FOR INTERNATIONAL DEVELOPMENT (AusAID)
Dr Geepa Gajjar Health and HlV Thematic Group Australian Agency for International Development (AusAID) Canberra, ACT 2601 Australia Tel. No.: 61 0226064176 E-mail: Deepa.Gajjar@ausaid.gov.au Mr Robert Turare Senior Programme Officer, Port Moresby Office Locked Bag 129 WaiganiNCD Papua New Guinea
DEPARTMENT OF HEALTH AND AGEING, AUSTRALIA
Dr Jenny Firman Medical Adviser Surveillance Branch Office of Health Protection Department of Health and Ageing 1 Bowes Place, Woden ACT Australia Tel No.: 61 0262892705 Fax No: 61 262892600 E-mail: Jenny.Firman@health.gov.au Dr Matthew Bankowski V ice President and Technical Director Microbiology and Infectious Disease Diagnostic Laboratory Services, Inc. 650 lwilei Road, Suite 300 Honolulu Hawaii 96817 Tel. No.: (808) 589-5242 Fax No.: (808) 589 5215 E-mail: mbankowski@dlslab.com
DIAGNOSTIC LABORATORY SERVICES, INC. (DLS)
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OCCUPATIONAL INFECTIOUS DISEASES-SCREENING
Ms Susanne Devlin Transitional Nurse Occupational Infectious Diseases-Screening 31 Uralba Street Lismore 2480 Australia Tel No.: 612 6620 7528 E-mail: :Sue.Devlin@ncahs.health.nsw.gov.au
QUEENSLANDTUBERCULOSffi CONTROL CENTRE
Mr Terence Obrien Clinical Nurse Consultant Queensland Tuberculosis Centre 24-28 Cornwall Street Annerley 4103 Queensland Australia Tel. No.: 0738963947 Fax No.: 0738963984 E-mail: terryobrien@health.gld.gov.au Dr KashefIjaz Chief Field Services and Evaluation Branch Division of Tuberculosis Elimination Centers for Disease Control and Prevention Mailstop E-IO, 1600 Clifton Road Atlanta, Georgia - 30333 USA Phone No.: 404-639-5314 Fax No.: 404-639-8959 E-mail: kiI6@CDC.GOV
UNITED STATES CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
5. SECRETARIAT
Secretariat of the Pacific Comm unity (SPC)
Dr Janet 0' Connor TB Specialist Secretariat of the Pacific Community BPD5, 98848, Noumea Cedex New Caledonia Tel. No.: +687 260116 Fax No.: +687 263818 E-mail: janeto@Syc.int
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Dr Axel Wiegandt Medical Officer High Complexity Tuberculosis, Secretariat of the Pacific Community BPD5 Cedex 98848 - Noumea New Caledonia Tel.: (687) 262000 Email: Axelw@spc.int Mr Albert Gurusami Laboratory Specialist Secretariat of the Pacific Community BPD5Cedex 98848 - Noumea New Caledonia Tel. No. (687) 262000 ext 422 E-mail: albertg@sPC.int Ms Kay Withnall Tuberculosis Laboratory Consultant 29 Sanford Street Woodleigh Gardens Northern Territory 0812 Australia Tel.: (618) 89271540 Email: kwithnall@octa.net.au Ms Marie-Ange Roberts Project Administrator Secretariat of the Pacific Community BPD5 Cedex 98848 - Noumea New Caledonia Tel. No.: (687) 262000 Email: Marieanger@spc.int
Mr Bertold Schmitt Interpreter Secretariat of the Pacific Community BPD5 Cedex 98848 - Noumea New Caledonia Tel. No.: (687) 262000 E-mail:
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Ms AurcHie Hamaide Interpreter Secretariat of the Pacific Community BP D5 Cedex98848 - Noumea New Caledonia Tel.: (687) 262000 Email: Aurelieh@spc.int
WHOIWPRO
Dr Pieter van Maaren (Responsible Officer) Regional Adviser Stop TB and Leprosy Elimination WHOIWPRO V.N.Avenue 1000 Manila Philippines Tel. No.: (632) 528 9706 Fax No.: (632) 521 1036 E-mail: vanmaarenp@wpro.who.int Dr Philippe Glaziou (Co-Responsible Officer) Medical Officer Stop TB and Leprosy Elimination WHO/WPRO V.N.Avenue 1000 Manila Philippines Tel. no.: (632) 528 9708 Fax no.: (632) 521 1036 E-mail: glazioup@\ypro.who.int Dr Masaki Ota Medical Officer Stop TB and Leprosy Elimination WHOIWPRO V.N.Avenue 1000 Manila Philippines Tel. no.: (632) 528 9708 Fax no.: (632) 521 1036 E-mail: otam@wpro.who.int
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Dr Jamhoih Tonsing Medical Officer Stop TB and Leprosy Elimination WHOIWPRO U.N. Avenue 1000 Manila Philippines Tel.: (632) 528 9720 Fax: (632) 521 1036 E-mail: tonsingj@wnro.who.int Mr Bernard Tomas Technical Officer Stop TB and Leprosy Elimination WHOIWPRO U.N. Avenue 1000 Manila Philippines Tel. no.: (632) 528 9727 Fax no.: (632) 521 1036 E-mail: tomasb@wpro.who.int Dr Nguyen Nhat Linh Medical Officer WHO Representative Level 4 Provident Plaza One Downtown Boulevard 33 Ellery Street, Suva Fiji Tel. No.: (679) 3234106 Fax No.: (679) 3234177 E-mail: nguyenli@wpro.who.int
ANNEX 2 TIMETABLE FOURTH PACIFIC STOP TB MEETING Brisbane, Australia, 11-14 March 2008 TIme 08:30 09:00
Tuesday, 11 Marth Registration Opening ceremony Opening remarks • WHO • SPC • Queensland Hea1th
nme 08:30
Wed~ad.y.ll ~
n~e
.
(Ti.Ii'r.s.,(trJli 13 March (15) Laboratory session (a) Report from PaTLab (b) PTRL - Queensland report (c) PTRL - Adelaide report (d) PTRL - Wellington report (e) Report from OLS. Hawaii
nme 08:30
·=.i!UM;lTCh (I7) Presentation of country workplans
(7) Recording and Reporting (a) How WHO utilizes data from annual reports (b) SPC data collection process and data management (8) Contact tracing: Report on SPC training course and next steps Parallel session: WorkshoI1 with
08: 30
09:30
USAPI lal:! mooagers 10:00 10:30 10:45 11:10 11:35 (2) Global & regional TB situation
PHOTO SESSIONffEA BREAK (1) Aims and objectives
10:00 10:30 11:00 (9)
TEA TB in children
BREAK
10:00 10:30
TEA
BREAK
10:00 10:30
TEA
BREAK
(to) International Standards for TB Care and Patients Charter
11:30
(11) TB and diabetes PariJUel ~e~siQn; One-Qn-one ~essions (lab consuitlIDts and llID managers)
(3) TB situation in the Pacific
Laboratory session (continued) (f) New tools (g) EQA-roles ofNTPs (h) Safety in the TB lab (i) Role ofTB culture in the Pacific (j) Drug resistance surveillance
(18) Conclusions and recommendations
III Closing ceremony
12:00
(4) Revised Regional TB-HIV Framework LUNCH BREAK
12:00
LUNCH
BREAK
12:00
LUNCH
BREAK ---
---
f t>J
TIme 13:30
Tuesday, 11 Marcb (5) Drug- resistant TB (a) Gtobal situation ofMDRlXDR TB (b) MDR-TB responseforthe Pacific (c) Green Light Committee (d) Country experience with MDR-TB case (Samoa) (e) Infection control TEA BREAK
TIme 13:30
Wedaaday, U Marcb (12) Drug management (a) Global Drug Facility (b) Group work: Stock review and plans for next procurement (13) Poster session: Country presentations
TIme
TIme
.Tlrlmttlay.13 M_ 13:30 (16) Group work: Country workplans for 2008-2009
FrfIIJ41;J4;M.,." Visit to QMRL at Royal Brisbane Hospital, Herston (optional)
I I ,
14:30
15:30 16:00 -
15:30 16:00 17:00
TEA BREAK
15:30 16:00
TEA BREAK
17:00
(6) Global Fund (a) Lessons learnt from the previous round (b) Briefing on Global Fund Round 7 (c) Discussion on Global Fund Round 2 evaluation ParaJlel session: Meeting of laboratoQ:' consultants and interested Rarties -..
(14) Meeting with partners
Group work (continued»
-
-
17:00
------
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I
~
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Annex 3 PRESENTATION OF FUTURE ACTIVITIES INVOLVING PATLAB PARTNERS
PATLAB
Four Years of Pacific TB Laboratory Initiative (PaTLab) David Daw50n Brisbane AUSTRALIA
Rationale • Geographic isolotion of most PIC • low workloads I case numbers in most PIC • Need for QA of microscopy services in PIC • Need for data on drug resistance in PIC • few Pacific lobs performing culture and DST • Opportunity to build on existing links between certain PIC and mainland reference labs
......
• Opportunity for partnership by CDC/SPC/WHO
PATLAS ""~nor . CDC SPC WHO Agendeo
PATLAB Initiative (a. planned)
Plicffk: TS Rete",,"
Llbor1l:ory Networtt
Pacific TB Laborliori.. ... 1111 ..... _ .. JB ..... _
Wellington
. PATLAB Initiative (to mld- 2007)
PATLAB Initiative (since mid- 2007)
Wtl6ngton
Wellington
1
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Pac:lfic: TB Referenc:e Lab Network Objectives • •
PAlLAB Partnel1lhlps
Provide scientific/technical advice to agencies Provide technical support, training. to PIC labs
• •
Develop eOA programmes in PIC labs Conduct drug resistance surveys in selected PIC Samoa
•
Collaborate in collection of data on EQA pnd DR
;oe==:=--
Klriboti
---::::rr:
""''''''
Pac:ific: TBReferenc:e Lab Network Tec:hriical Support, Training • •
Pac:ific: TB Referenc:e Lab Network Develop EQA Programmes • • • • • • EQA through on·site evaluations. panel tests and blinded slide rechecking Standard EQA Pacific Gvidelines ("Slve Book") Key Performance Indicators developed for US-PIC On-site evalvations in almost all PIC (check-lists) Annual PTs in aU US·PIC, occasional in others BSR in 8 PIC; limited BSR in all US·PIC
Site visits, sub-regionol training courses, PlrCA Lob specialists from PTRLs, CDC, ARC, WHO
• • • •
Standard training curriculum developed Training provided to tachs from 22 countries Site visits to majority of PIC Financial support for AFM Handbook {IMVSj
«/1&0,; mltlfMf'W;tI<;
...
Pacific: TB Referenc:e Lab Network Conduct DRS Projects • Almost no
Key Findings in DRS DR in Fiji, Solomons and Vanuatu (DRS)
• • • • • • ..
Expanded testing for Fiji &. Solomons (complete) Conducted first DRS project in Vanuatu 2005-06 Emphasis on case-specific testing in smaller PICs Majority of cases in US-PIC now tested for DR Better patient history is essential to maximise value Totol reliance on PTRls for DSTs 18111 ... .......,
• • • • • •
Generalty low levels of OR in Polynesia, Melanesia Aware of MDR cases in Kiribati, Samoa DST on aillab-confirmed cases in USAP1/Micronesia Much higher levels of OR (popn movements, garment wor1c:e~, etc) Several proven MDR cases in RMI, CNMI, FSM, Guam Occasional cases of moncxesistance to RIF
...... 2
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PATLAB Summary of Achievements (1) • • • • • Built collaboration between CDC/SPC/WHO Introduced locol microscopy services in 2 PIC Extended local microscopy services in 2 PIC Increased the number of TB-proficient lob techs Increosed level of skills/knowledge of lob techs • • • • • • •
PATLAB Summary of Achievements (2) Collected first data on TB DR in PIC Increased coverage of DST testing in PIC Provided cose-specific DST (failures, relapses) Established expert consultation network (MDR) Improved procedures for specimen collection Contributed to more efficient shipping protocols Developed enhanced lab register (culture)
• • •
introduced standard ZN-staining methodology Raised awareness/commitment to Biosofety Increased labs' participation in Quality Assurance
PATLAB Future ChaUenges • • • • • • •
Expand EQA by routine BSR Reduce reliance on PTRls for BSR
Provide annual PTs to non-US PIC Improve data c:ollection activities in PIC lobs Implement simple culture in selected PIC Improve dolo qlJO!ity in DR $urvei\lonce Develop standard TB Lab Manual template
• •
Provide DST services to support MDR/XDR Establish PTRL in pre {DS"
... --ra .. ". ....
-
3