Technical Advisory Group on Tuberculosis for the WHO European Region: report of the Twelfth Meeting: 19–20 February 2018, Copenhagen, Denmark

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Document number: WHO/EURO:2018-3337-43096-60319 Report of the Twelfth Meeting of the Technical Advisory Group on Tuberculosis for the WHO European Region, Copenhagen, Denmark, 19–20 February 2018 i Abstract The Twelfth Meeting of the European Technical Advisory Group on Tuberculosis was held in Copenhagen on 19–20 February 2018. The objectives of the Meeting were to: (i) review the progress made in implementing the recommendations of the Seventeenth Meeting of the Strategic and Technical Advisory Group for Tuberculosis and the Eleventh Meeting of the Technical Advisory Group on Tuberculosis; (ii) review the status of implementation of the Tuberculosis Action Plan for the WHO European Region 2016–2020; (iii) advise on measures to take to support Member States to achieve more impact against TB through a sustainable development approach; and (iv) advise on steps needed to build on political commitment from the Moscow Ministerial Conference to the United Nations General Assembly high-level meeting on tuberculosis. Report of the Twelfth Meeting of the Technical Advisory Group on Tuberculosis for the WHO European Region, Copenhagen, Denmark, 19–20 February 2018 ii Contents ABBREVIATIONS ....................................................................................................................... iii INTRODUCTION ......................................................................................................................... ..1 RECOMMENDATIONS .............................................................................................................. ..1 Overall recommendation to WHO Regional Office for Europe work on TB and X- and MDR-TB ....................................................................................................................................... ..2 Adopting a sustainable, intersectoral approach to combat TB ...................................................... ..2 Promoting political commitment and accountability for TB prevention and care ........................ ..3 Procedural recommendations for TAG-TB meetings ................................................................... ..3 ANNEX 1. SCOPE AND PURPOSE ........................................................................................... ..4 ANNEX 2. PROGRAMME .......................................................................................................... ..5 ANNEX 3. LIST OF PARTICIPANTS ....................................................................................... ..7 Report of the Twelfth Meeting of the Technical Advisory Group on Tuberculosis for the WHO European Region, Copenhagen, Denmark, 19–20 February 2018 iii Abbreviations HIV human immunodeficiency virus MDR-TB multidrug-resistant tuberculosis TAG-TB Technical Advisory Group on Tuberculosis TB tuberculosis UN United Nations UNGA United Nations General Assembly XDR-TB extensively drug-resistant tuberculosis Report of the Twelfth Meeting of the Technical Advisory Group on Tuberculosis for the WHO European Region, Copenhagen, Denmark, 19–20 February 2018 1 Introduction The Twelfth Meeting of the European Technical Advisory Group on Tuberculosis (TAG-TB) was held in Copenhagen, Denmark, on 19–20 February 2018. The overall objective of TAG-TB is to provide an independent review and expert technical opinion regarding tuberculosis (TB), drug-resistant TB and HIV-associated TB to the WHO Regional Director for Europe. The specific objectives of the Meeting were to: • review the progress made in implementing the recommendations of the Seventeenth Meeting of the Strategic and Technical Advisory Group for Tuberculosis and the Eleventh Meeting of TAG-TB (13– 14 February 2017); • review the status of implementation of the Tuberculosis Action Plan for the WHO European Region 2016–2020; • advise on measures to support Member States to improve TB prevention and care through a sustainable development approach; and • advise on steps to build on the political commitment from Moscow Ministerial Conference to the United Nations General Assembly (UNGA) high-level meeting on TB in September 2018. The scope and purpose, programme, and list of participants of the Meeting can be found in Annexes 1–3. The Meeting was chaired by Professor Alberto Matteelli. TAG-TB congratulated the WHO Regional Office for Europe and Member States of the Region on their achievements over the last year. The substantial actions taken by the Regional Office and consequently by Member States have had significant results: TB incidence rates are decreasing across many countries. However, challenges remain: the proportion of multidrug-resistant TB (MDR-TB) cases is increasing, numbers of TB/HIV coinfection cases are rising and challenges remain in reforming the health care systems towards ambulatory TB care. These trends all need to be addressed. The UNGA high-level meeting on TB in September 2018 will support the Regional strategy for effective intersectoral actions and to leave no one behind in ending TB. TAG-TB congratulates the Regional Office for organizing this event. Recommendations This section lists the main recommendations of TAG-TB including, where relevant, for reports to be produced for presentation at the Thirteenth TAG-TB Meeting in 2019. Report of the Twelfth Meeting of the Technical Advisory Group on Tuberculosis for the WHO European Region, Copenhagen, Denmark, 19–20 February 2018 2 Overall WHO Regional Office for Europe work on TB and M- and XDR-TB 1. Continue discussions with recipient countries of the Global Fund to Fight AIDS, Tuberculosis and Malaria on the transition to domestic financing mechanisms for TB detection, treatment and care. Together with the Member States, analyse and highlight areas at risk of suffering a funding gap after 2020, and discuss future actions with the Member States and the Global Fund. Product: an internal report. 2. Collect and share the best case studies of MDR-TB prevention and care at the national level (possibly from Kazakhstan, Latvia and Lithuania), including the effectiveness and safety of transitioning from hospital-based to ambulatory-based care for extensively drug-resistant TB (XDR-TB) and MDR-TB patients. Ideally, a description of drug resistance patterns in XDR-TB strains to be included. Product: WHO Regional Office for Europe publication. 3. Continue implementing the European Respiratory Society/WHO TB e-Consilium and encourage Member States to complement and strengthen this with national and subnational committees/consiliums for managing X- and MDR-TB. National committees/consiliums to ideally use electronic platforms for communication, with support from the Regional Office. Product: internal report, to be presented at the Thirteenth TAG-TB Meeting. 4. WHO has just published the global policy document on isoniazid resistance and use of fluoroquinolones, WHO treatment guidelines for isoniazid-resistant tuberculosis. An expert panel (including the regional Green Light Committee) is to be convened to determine whether the Regional Office is to follow the global recommendation. To provide relevant information for the panel, the Regional Office to analyse drug-resistance patterns in selected high-priority countries, paying special attention to isoniazid resistance by mutation type and quinolone resistance. Product: an expert panel report. 5. Develop a set of minimum standards for palliative care (including psychosocial and educational support) for XDR-TB patients and include palliative care as a discussion topic in the Thirteenth TAG- TB Meeting in 2019. Product: an internal report. Adopting a sustainable, intersectoral approach to combat TB 6. Promote the strategy to combat TB at both country and regional levels using an intersectoral approach by encouraging the use of existing mechanisms and platforms (e.g. national strategic plans, country coordinating mechanisms, United Nations Development Assistance Frameworks) and to support WHO country officers to work with government ministers to encourage intersectoral collaboration. 7. Support national TB prevention and care programmes to work with ministries beyond the health ministry (e.g. Ministry of Justice, Ministry of Education, Ministry of Social Affairs, Ministry of Finance) and encourage Member States to update national TB action plans to include intersectoral actions and sustainable development. 8. Work with Member States to embed TB prevention and care into a model that encourages adoption of a whole-of-government approach to tackle the wider social determinants of TB by bringing together stakeholders from health and non-health backgrounds. 9. Support Member States in empowering front-line staff in the health sector and beyond (e.g. doctors, TB nurses, social workers, TB support workers and police) to pursue a more people-centred model of Report of the Twelfth Meeting of the Technical Advisory Group on Tuberculosis for the WHO European Region, Copenhagen, Denmark, 19–20 February 2018 3 care and to actively mediate the interface between health care services and patients to build trust within communities. Promoting political commitment and accountability for TB prevention and care TAG-TB recommends the following actions to ensure the 2018 UNGA high-level meeting on TB builds on the level of political commitment achieved at the Moscow Ministerial Conference. 10. Together with partners, advocate for high-level political representation beyond the ministries of health, as well as representation from civil society organizations, in country delegations to the upcoming UNGA meeting, paying special attention to high-priority countries. 11. Support Member States (especially high-priority countries) in packaging country-specific advocacy material for non-health sector stakeholders/ministers prior to the UNGA meeting. This could include: • a brief factsheet/infographic for non-health sector stakeholders covering the core facts on TB and the benefits of investing in TB (e.g. $ 1 spent leads to $ 43 saved, as reported at the Moscow Ministerial Conference); • a brief factsheet/infographic illustrating the wider social determinants of TB; • an overview of the core actions needed to end TB in the country; and • an updated country profile. 12. Advocate for the global accountability framework to include the monitoring of political commitment and social indicators, as well as epidemiological indicators. 13. Together with high-priority countries, develop a strategy/action/follow-up plan for implementation after the UNGA, using existing platforms and frameworks. Procedural recommendations for TAG-TB meetings 14. Recommendations made at the Eleventh Meeting of TAG-TB which have not yet been achieved to be carried forward and reported on at next TAG-TB meeting (including recommendations on access to second-line drugs, national barriers and the adoption of short treatment regimens). 15. More specific progress reports on TAG-TB recommendations to include descriptions of inputs, output/products and possible outcomes (if any). A progress report on recommendations from the Eleventh Meeting of TAG-TB in 2017 to be shared with TAG-TB members two months after the Twelfth Meeting of TAG-TB. 16. Presentations and other relevant materials to be provided to members two weeks before the Thirteenths Meeting of TAG-TB. 17. A midterm virtual TAG-TB meeting (by video) to be arranged to evaluate the implementation status of the latest TAG-TB recommendations. Report of the Twelfth Meeting of the Technical Advisory Group on Tuberculosis for the WHO European Region, Copenhagen, Denmark, 19–20 February 2018 4 Annex 1. Scope and purpose Main objective To provide independent review and expert technical opinion in prevention and care of TB, drug-resistant TB and HIV-associated TB to the Director of the WHO Regional Office for Europe. Specific objectives The specific objectives of the Twelfth Meeting of TAG-TB were to: 1. review the progress made in implementing the recommendations of the Seventeenth Meeting of the Strategic and Technical Advisory Group for Tuberculosis and the Eleventh Meeting of TAG-TB; 2. review the status of implementation of the Tuberculosis Action Plan for the WHO European Region, 2016–2020; 3. advise on measures to take to support Member States to achieve higher impact on TB through a sustainable development approach; and 4. advise on the steps to take to build on political commitment from Moscow Ministerial Conference to UNGA high-level meeting on TB Report of the Twelfth Meeting of the Technical Advisory Group on Tuberculosis for the WHO European Region, Copenhagen, Denmark, 19–20 February 2018 5 Annex 2. Programme Day 1. 19 February 2018 SESSION 1 Introduction 10:00–10:10 Opening Nedret Emiroğlu, Director, Division of Health Emergencies and Communicable Diseases (DEC) 10:10–10:25 Review of the terms of reference and membership of TAG-TB; review of the declarations of conflict of interest, election of vice-chair of TAG-TB Masoud Dara, Coordinator, Communicable Diseases & Programme Manager, Joint Tuberculosis, HIV & viral Hepatitis (JTH) SESSION 2 Updates 10:25–10:45 Summary of the recommendations from the 17th Meeting of the Strategic and Technical Advisory Group for TB (STAG-TB), Geneva, 12–14 June 2017, and of the Global Ministerial Conference on Ending TB in the Sustainable Development Era, Moscow, 16 –17 November 2017 Irina A. Vasilyeva, Member of STAG-TB and Chief TB Specialist of the Ministry of Health, Moscow, Russian Federation 10:45–11:05 Update on implementation of the Tuberculosis Action Plan for the WHO European Region, 2016-2020 Martin van den Boom, Technical Officer, JTH 11:05–11:30 Questions and answers, discussion 11:30–11:50 Progress in the implementation of the recommendations from the 11th Meeting of TAG-TB, Copenhagen, 13-14 February 2017 Martin van den Boom 11:50–12:10 Overview of the TB epidemiology in the WHO European Region Ms Annemarie Rinder-Stengaard 12:10–12:35 Discussion 12:35–12:45 Group photo SESSION 3 Specific questions to TAG-TB 14:00–14:45 Achieving higher impact on TB prevention and care in the WHO European Region in the era of SDGs and through a sustainable development approach Presenter: Vittoria Gemelli Discussant: Sarah R. Anderson, TAG-TB 15:15– 16:15 Discussion 16:15–16:45 Wrap-up and closure of the day Report of the Twelfth Meeting of the Technical Advisory Group on Tuberculosis for the WHO European Region, Copenhagen, Denmark, 19–20 February 2018 6 DAY 2. 20 February 2018 09:00–09:30 Steps to take to build on political commitment from Moscow Ministerial Conference to UNGA high level meeting on TB Presenter: Masoud Dara Discussant: Alberto Matteelli, TAG-TB 09:30–10:30 Discussion 10:50–12:50 Discussion on the main recommendations of the TAG-TB 12th Meeting 12:50–13:00 Closure of the TAG-TB Twelfth Meeting Masoud Dara Nedret Emiroğlu Report of the Twelfth Meeting of the Technical Advisory Group on Tuberculosis for the WHO European Region, Copenhagen, Denmark, 19–20 February 2018 7 Annex 3. List of participants TAG-TB Members Dr Sarah R. Anderson Head, National TB Office, National Infection Service, Public Health England, London, United Kingdom sarah.anderson@phe.gov.uk Ms Tsira Chakhaia TBPEOPLE, Tbilisi, Georgia tschakhaia@gmail.com Mr Alexandre Lourenco Hospital Administrator, Coimbra Hospital and University Centre, Coimbra, Portugal alexander.lourenco@icloud.com Professor Alberto Matteelli Chair of TAG-TB and Director, WHO Collaborating Centre on TB/HIV and TB Elimination, University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital alberto.matteelli@unibs.it Dr Nigorsulton Muzafarova Lead Product Quality Officer, Stop TB Partnership Secretariat, Geneva, Switzerland nigorsultonm@stoptb.org Dr Natalya Nizova Public Health Specialist, Kyiv, Ukraine natalya.nizova@gmail.com Report of the Twelfth Meeting of the Technical Advisory Group on Tuberculosis for the WHO European Region, Copenhagen, Denmark, 19–20 February 2018 8 Dr Leen Rigouts Director, Unit of Mycobacteriology, Institute of Tropical Medicine, Antwerp, Belgium LRigouts@itg.be Professor Irina A. Vasilyeva (member of the Strategic and Technical Advisory Group for Tuberculosis) Director, Research Institute of Phthisiopulmonology I.M. Sechenov, Chief TB Specialist, Ministry of Health, Moscow, Russian Federation vasil39@list.ru Dr Askar Yedilbayev Programme Director for the Russian Federation and Kazakhstan, Partners in Health, Boston, USA askar@pih.org Temporary Advisers Professor Giovanni Sotgiu Professor of Medical Statistics and Clinical Epidemiology, Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, Faculty of Medicine, University of Sassari, Sassari, Italy gsotgiu@uniss.it Observers Ms Isabela Barbosa Technical Adviser, Joint United Nations Programme on HIV/AIDS' Special Advisor for HIV, Geneva, Switzerland isabela@michelkazatchkine.com Dr Stela Bivol Director, Center for Health Policies and Studies (PAS Center), Chişinău, the Republic of Moldova Stela.Bivol@pas.md Report of the Twelfth Meeting of the Technical Advisory Group on Tuberculosis for the WHO European Region, Copenhagen, Denmark, 19–20 February 2018 9 Mr Lasha Goguadze Senior Health Officer, International Federation of Red Cross and Red Crescent, Geneva, Switzerland Lasha.Goguadze@ifrc.org Dr Davron Mukhamadiev Regional Health and Care Coordinator for Europe, International Federation of Red Cross and Red Crescent Societies, Budapest, Hungary davron.mukhamadiev@ifrc.org Dr Svetlana Nicolaescu Program Coordinator, Center for Health Policies and Studies (PAS Center), Chişinău, Republic of Moldova svetlana.nicolaescu@pas.md Mr Paul Sommerfeld Director, TB Alert, Brighton, United Kingdom paul.sommerfeld@tbalert.org Dr Marieke van der Werf Head of Tuberculosis Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden Marieke.vanderWerf@ecdc.europa.eu World Health Organization WHO Regional Office for Europe Dr Andrei Dadu Medical Officer, Joint TB, HIV and Viral Hepatitis programme dadua@who.int Report of the Twelfth Meeting of the Technical Advisory Group on Tuberculosis for the WHO European Region, Copenhagen, Denmark, 19–20 February 2018 10 Dr Masoud Dara Coordinator, Communicable Diseases & Programme Manager, Joint Tuberculosis, HIV and Viral Hepatitis programme daram@who.int Dr Nedret Emiroğlu Director, Division of Health Emergencies and Communicable Diseases emiroglun@who.int Dr Sayohat Hasanova Technical Officer, Joint Tuberculosis, HIV and Viral Hepatitis programme hasanaovs@who.int Dr Antons Mozalevskis Medical Officer, Joint Tuberculosis, HIV and Viral Hepatitis programme mozalevskisa@who.int Mr Bhim Pradhan Administrative Assistant, Joint Tuberculosis, HIV and Viral Hepatitis programme Pradhanb@who.int Ms Vittoria Gemelli Consultant, Joint Tuberculosis, HIV and Viral Hepatitis programme gemelliv@who.int Ms Annemarie Rinder Stengaard Epidemiologist, Joint Tuberculosis, HIV and Viral Hepatitis programme bollerupa@who.int Report of the Twelfth Meeting of the Technical Advisory Group on Tuberculosis for the WHO European Region, Copenhagen, Denmark, 19–20 February 2018 11 Dr Martin van den Boom Technical Officer, Joint Tuberculosis, HIV and Viral Hepatitis programme vandenboomm@who.int Ms Regina Winter Consultant, Division of Health Systems and Public Health winterr@who.int WHO European Region Country Offices Dr Gazmend Bejtja National Public Health Officer, WHO Country Office, Tirana, Albania bejtjag@who.int Dr Gayane Ghukasyan National Professional Officer, WHO Country Office, Yerevan, Armenia ghukasyang@who.int Dr Viatcheslav Grankov National Professional Officer, WHO Country Office, Minsk, Belarus grankovv@who.int Dr Nino Mamulashvili National Professional Officer, WHO Country Office, Tbilisi, Georgia mamulashvilin@who.int Mr Szabolcs Szigeti National Professional Officer, WHO Country Office, Budapest, Hungary szigetis@who.int Report of the Twelfth Meeting of the Technical Advisory Group on Tuberculosis for the WHO European Region, Copenhagen, Denmark, 19–20 February 2018 12 Dr Gazmend Zhuri National Professional Officer, Pristina, Kosovo (in accordance with United Nations Security Council Resolution 1244 [1999]). zhurig@who.int Dr Cassandra Butu National Professional Officer, WHO Country Office, Bucharest, Romania butua@who.int Dr Nikita Afanasyev National Professional Officer, WHO Country Office, Moscow, Russian Federation afanasyevn@who.int Ms Ekaterina Simko Administrative Assistant, WHO Country Office, Moscow, Russian Federation simkoe@who.int Dr Jamshid Gadoev National Professional Officer, WHO Country Office, Tashkent, Uzbekistan gadoevj@who.int Mr Mustafa Bahadir Sucakli National Professional Officer, WHO Country Office, Istambul, Turkey sucaklim@who.int Rapporteur Nina Bjerglund Andersen Public Health Science Communication 2.0, Copenhagen, Denmark ninabjerglund@gmail.com The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: eucontact@who.int Website: www.euro.who.int WHO/EURO:2018-3337-43096-60319