stop tb partnership Annual Report 2010 Abbreviations ACSM Advocacy, communication and social mobilization NGO Nongovernmental Organization AIDS Acquired Immune Deficiency Syndrome PEPFAR (US) President’s Emergency Plan for AIDS Relief CFCS Challenge Facility for Civil Society PPM Public-private mix CIDA Canadian International Development Agency STAG-TB Strategic and Technical Advisory Group for Tuberculosis CGI Clinton Global Initiative TAG Treatment Action Group DFID United Kingdom Department for International Development TB Tuberculosis DOTS The basic strategy that underpins the Stop TB Strategy TBTEAM Tuberculosis Technical Assistance Mechanism of the Stop TB Partnership EXPAND-TB Expanding Access to New Diagnostics for TB (project) UNAIDS Joint United Nations Programme on HIV/AIDS GDF Global Drug Facility UNITAID An international funding facility set up to accelerate treatment GLC Green Light Committee of HIV/AIDS, malaria and tuberculosis in developing countries GLI Global Laboratory Initiative USAID United States Agency for International Development HIV Human immunodeficiency virus WHO World Health Organization MDR-TB Multidrug-resistant tuberculosis XDR-TB Extensively drug-resistant tuberculosis
Photo credits: Rebeccah Hearding, Pierre Abensur, Jean Chung, David Rochkind, Jennifer Dietrich, UNAIDS, Matthew Willman, Sam Nuttall, Tobias Hofsass, Riccardo Venturi, Misha Friedman.
© World Health Organization Co 2 | Foreword
4 | Executive Summary ntents 8 | The Global Plan to Stop TB 2011 – 2015
12 | Governance
14 | Partner Engagement
20 | Challenge Facility for Civil Society
22 | TB REACH
26 | Political Advocacy
30 | UN Secretary-General’s Special Envoy to Stop Tuberculosis
32 | Communications, Celebrities and Events
38 | Working Groups
44 | TB Research Movement
45 | TB TEAM
46 | The Global Drug Facility
50 | Resource Mobilization and Financial Management
52 | Annexes
About the Stop TB Partnership
The Stop TB Partnership is leading the way to a world without tuberculosis (TB), a disease that is curable but still kills three people every minute. Founded in 2001, the Partnership’s mission is to serve every person who is vulnerable to TB and ensure that high-quality treatment is available to all who need it. Our role is to ensure a bold vision for addressing TB and to coordinate and catalyse global efforts towards elimination of the disease.
Together our nearly 1000 partners are a collective force that is transforming the fight against TB in more than 100 countries. They include international and technical organizations, government programmes, research and funding agencies, foundations, NGOs, civil society and community groups and the private sector.
We operate through a secretariat hosted by the World Health Organization (WHO) in Geneva, Switzerland and seven working groups whose role is to accelerate progress on access to TB diagnosis and treatment; research and development for new TB diagnostics, drugs and vaccines; and tackling drug resistant- and HIV-associated TB. The secretariat is governed by a coordinating board that sets strategic direction for the global fight against TB. & was both
2010 an anniversary year a year for making history.
Foreword Foreword
2 It is my pleasure to present to you the Stop TB Partnership’s Annual Report 2010. This was both an anniversary year and a year for making history.
It saw the development and reduced transmission and to have had the opportunity to launch of a new roadmap for the prevention of the emergence steward this exciting new initiative Partnership – the Global Plan to of drug-resistant forms of TB. through its first year, and at the Stop TB 2011 – 2015: Transforming As suggested by its name, end of that year to have been the Fight Towards Elimination TB REACH focuses on reaching selected as the Partnership’s of Tuberculosis. The new plan – people who have limited or no Executive Secretary. which follows on from the Global access to TB services. Plan to Stop TB 2006 – 2015, I have taken up my duties in while setting new and more 2010 was a milestone year in our challenging times, but these ambitious targets – for the first efforts to turn up the volume about challenges will not weaken my time identifies all the research TB among groups committed to resolve. We serve people all over gaps that need to be filled to bring fighting human immunodeficiency the world who are vulnerable to rapid TB tests, faster treatment virus (HIV). There was an historic TB. It is our task to change the regimens and a fully effective moment at the International AIDS world so that all people who need vaccine to market. It also shows Conference – a protest march TB care can access it, no matter public health programmes how calling for no more deaths from who they are or where they live. to drive universal access to TB TB in people living with HIV, Our partners share this vision, care, including how to modernise followed by a plenary session and if we work together we will diagnostic laboratories and adopt on TB/HIV featuring the United realise it. revolutionary TB tests that have Nations (UN) Secretary General’s become available recently. Special Envoy to Stop TB, We can do it only in partnership! Dr Jorge Sampaio. The session In another historic development, culminated in the signing of a Dr Lucica Ditiu the Stop TB Partnership launched memorandum of understanding Executive Secretary, the TB REACH initiative. between the Stop TB Partnership Stop TB Partnership Supported by the Canadian and the Joint United Nations International Development Agency Programme on HIV/AIDS (UNAIDS). (CIDA), TB REACH funds projects The agreement binds the two that promote early and increased organizations together in a case detection of people with TB common goal: To strive towards and ensure their timely treatment, halving the number of people while maintaining high cure rates living with HIV who die from TB by within national TB programmes. 2015, compared with 2004 levels. TB REACH encourages the development and application of 2010 was also a landmark for me innovative, groundbreaking and personally. It was the year I joined efficient techniques, interventions the Stop TB Partnership as team and activities that result in leader for the newly established increased TB case detection, TB REACH. I felt so privileged
Foreword 3
lan to P care and research which needs to be filled by international donors. The goals set out in the Global Plan gave fresh impetus to the partnership’s work at a country level. At the end thereof 2010 were 32 country-level partnerships. Bringing together organizations from different sectors of society, these partnerships have drawn up shared operational plans which aim to maximise resources and increase coordination with national TB programmes. Swaziland, for example, has reported excellent results following the development of a shared fiveyear planto combat TB. The case detection rate has increased from 43% to 70% and the treatment success rate has increased from to 68%. 47%
2015 inshowed 2015 2010
–
2015, the2015, new plan
2011 –
TB he launch of the Global Stop the power of partnership in action. and sets ambitious targets for testing and treating people who are co-infected with TB and HIV. The plan is fully costed and identifies a funding gap of around US $21 billion, approximately US $4 billion a year, for both TB the plan for the first time identifies the research gaps that need to be filledto bring rapid TBtests, faster treatment regimens and a fully effective vaccine to market. The plan provides a clear roadmap for addressing drug-resistant TB draws on expertise from across the partnership to pave the way to eliminating TB as a global health problem. As well as showing public health programmes how to drive universal access to TB care, T An update to the Global Plan to Stop TB 2006 xecutive summary
Executive summary E
4 The treatment success rate from in Swaziland has increased to 47% 68 %
The launch of TB REACH in The Challenge Facility for Civil TB and HIV was a key topic in 2010. January brought new hope to the Society continued its work to The Partnership had a strong estimated three million people a empower communities in the fight presence at the International AIDS year with TB who fail to access against TB, awarding a third round Conference in July, with several accurate diagnosis or effective of grants worth between US$ 5 000 key events including a symposium treatment. Supported by CIDA, and US$ 20 000 to 22 civil society on TB/HIV coninfection in eastern the fast track funding mechanism organizations across the globe Europe. Protesters calling for approved 30 projects in 2010 in 2010. These grants supported “no more deaths from TB in people which are designed to encourage various community-level activities, living with HIV” marched through increased case detection including public forums, door- the conference centre in advance using innovative techniques to-door outreach, distribution of of a special session on TB/HIV. and activities. Early results are communication materials, reduction At a special ceremony convened encouraging. A project run by of stigma in the workplace, and by Dr Jorge Sampaio, the United the Indus Hospital in Karachi, enhancing support from local Nations Secretary General’s Pakistan, has reported a doubling leaders and women’s groups. Special Envoy on Tuberculosis, in the number of cases detected In Cote D’Ivoire, one community the Stop TB Partnership signed following the implementation of a organization has increased a memorandum of understanding new programme that uses mobile case detection three-fold after with UNAIDS to work together to phone technology and financial implementing advocacy initiatives, improve the response to TB and HIV. incentives to track down people community events and education with tuberculosis. for community volunteers.
Executive summary 5 The Global Drug Facility continued drug market, purchasing capacity and Social Mobilization (ACSM) its work to ensure the delivery of first and logistics expertise. The total Subgroup launched a collection of and second-line anti-tuberculosis value of orders placed through ACSM good practices during the drugs and diagnostics at sustainable GDF’s procurement service in 2010 Stop TB Symposium in Berlin. prices. Despite challenging was US$ 87 million, up from market conditions, GDF’s core US$ 48 million in 2009. In 2010, the TB Technical procurement business grew Assistance Mechanism (TB strongly in 2010. This equated In addition to their contributions TEAM) coordinated and planned to 2.3 million patient treatments to the Global Plan to Stop TB technical assistance missions and more than 12 000 MDR-TB 2011-2015, the partnership’s and supported 43 countries in patients enrolled under GLC working groups made some applying for Global Fund grants. projects. This brings the total notable advances in 2010. This support resulted in the number of first-line drug patient The Global Laboratory Initiative, mobilization of over US $ 1 billion treatments delivered by GDF New Diagnostics Working Group for TB control in countries from since 2001 to more than 18 and DOTS Expansion Working the Global Fund. million. Through its grant service, Group all contributed efforts GDF continued to provide first-line which led to the approval of Finally, the partnership continued drugs to countries that were the MTB/RIF diagnostic test by to raise public awareness and unable to secure the finances WHO in December. The MDR-TB understanding of TB. World TB needed. Forty-six countries placed Working Group produced a draft Day in 2010 marked the start grant orders for first-line drugs. framework for coordinating the of a new 2-year campaign. GDF witnessed fewer requests response to the MDR-TB epidemic The slogan “On the Move Against for grant funding in 2010 as many for endorsement by the Stop TB Tuberculosis” built on the theme countries transition from GDF Partnership Coordinating Board. of innovation and focussed on grants to Global Fund grants. The Childhood TB Subgroup of individuals who have found new However GDF’s procurement the DOTS Expansion Working ways to stop TB. The World TB services business grew strongly Group developed new policy Day blog was relaunched as a in 2010. This service allows guidelines on the treatment of TB vehicle for partners to share and clients to use their own funds or in children and a desktop guide publicise events and news. donor grants to source first and for the diagnosis and management In March, British singer Craig David second-line drugs through GDF, of TB in children. Meanwhile, joined the partnership to lend his leveraging its knowledge of the TB the Advocacy, Communication voice to the global fight against TB.
6 Executive summary A series of videos recorded during a trip to South Africa were released on YouTube and helped Since 2001, to generate more than 28 000 views on the Stop TB channel. GDF has sent more than In addition Craig gave several television interviews and posted 18.5 million messages throughout the year on patient treatments. his Twitter and Facebook pages. The Stop TB Partnership website, www.stoptb.org, continued to draw a broad audience with nearly 8 million visits in 2010, a 36% increase over 2009.
Executive summary 7 The Global Plan to Stop TB 2011– 2015
The Global Plan to Stop TB was launched in Johannesburg, South Africa in October. The press conference, held at Pholosho Primary School in Alexandra was followed by a Kick TB event involving 2000 school children. Kick TB is an initiative of the South African Department for Health which uses sport to spread awareness about TB and tackle the stigma associated with the disease.
8 The Global Plan to Stop TB 2011 – 2015 The Global Plan to Stop TB In addition to helping public In 2010 the Stop 2011 – 2015: Transforming the health programmes adopt already TB Partnership Fight Towards Elimination of existing modern diagnostic tests, Tuberculosis identifies for the first the Global Plan sets a research published a time the research gaps that need agenda aimed at engendering two to be filled to bring rapid TB tests, new ‘while-you-wait’ rapid tests comprehensive faster treatment regimens and a that trained staff at even the most fully effective vaccine to market. basic health outposts can use to plan which, The Global Plan also shows diagnose TB accurately. By 2015 if fully funded, public health programmes how the Global Plan also aims to have to drive universal access to TB three new drug regimens – one would pave the care, including how to modernise for drug-sensitive TB and two for diagnostic laboratories and how to drug-resistant TB – to be going way to eliminating adopt revolutionary TB tests that through phase III clinical trials, have recently become available. the final step before drugs are tuberculosis (TB) released to market. Four vaccine The Global Plan is an update to the candidates should be at the same as a global health Global Plan to Stop TB 2006 – 2015, stage of testing. problem. which was published in 2006. The new Global Plan follows the The Global Plan provides a earlier version, while setting new clear roadmap for addressing and more ambitious targets for drug-resistant TB. It calls for the next five years. 7 million people to be tested for multidrug-resistant TB (MDR-TB) The Global Plan sets out to and 1 million confirmed cases provide diagnosis and treatment treated according to international approaches recommended by the standards over the next 5 years. World Health Organization (WHO) for 32 million people over the next five years.
The Global Plan to Stop TB 2011 – 2015 9 Half a million people die each year On financing, the Global Plan per year. High-income countries from TB associated with human calls for US$ 37 billion for and countries with growing immunodeficiency virus (HIV) implementation of TB care economies will need to increase infection. If the Global Plan’s between 2011 and 2015. A funding their investment in research and targets are met, then by the end gap of about US$ 14 billion – development to fill a total estimated of 2015 all people with TB will approximately US$ 2.8 billion gap of about US$ 7 billion, or be tested for HIV and, if the test per year – will remain and needs to US$ 1.4 billion per year. is positive, receive antiretroviral be filled by international donors. drugs and other appropriate HIV care. In HIV treatment settings, The Global Plan includes a all patients will be screened separate calculation of the funding for TB and receive appropriate required to meet targets for preventive therapy or treatment research and development: a total as needed. of US$ 10 billion, or US$ 2 billion
Funding $37 required for implementation billion
10 The Global Plan to Stop TB 2011 – 2015 Funding required for $10 research billion
The Global Plan to Stop TB 2011 – 2015 11
am in N ctober 2010. ctober 2010. O anoi, Viet artnership Coordinating H P
TB Coordinating Board meeting in October. Dr Mphu Ramatlapeng, the Minister of Health and Social Welfare of Lesotho, speaking at the oard met in he Stop B T Mayand 2010 in Johannesburg, South Africa in
Governance Governance
12 At the 18th Stop TB Partnership The board requested a study to The board mandated the Coordinating Board meeting review the lessons learnt from the Secretariat to mobilize additional on 4 – 5 May in Hanoi, Viet Nam, first wave of applications for TB resources in 2010 – 2011 to ensure the Board discussed progress REACH grants. In addition, that activities in 2012 – 2013 are and the way forward on TB/HIV it endorsed recommendations to sustained at the same level and endorsed a memorandum of or above. It supported the enhance advocacy in the United understanding between the Joint finalisation of the Global Drug States of America, including better United Nations Programme on Facility (GDF) implementation and coordination, communications, HIV/AIDS (UNAIDS) and the Stop restructuring plan under the new support and leadership engagement. TB Partnership. This was finalised head of the GDF and supported and signed at the International AIDS This resulted in co-financing a post the TB Vaccine Blueprint process Conference in Vienna in July 2010. in Washington DC to improve the and asked for donor commitment coordination of advocacy partners. to expand funding for vaccines. The board endorsed the direction that partners involved in the At the 19th Stop TB Partnership At the special session of MDR-TB response have agreed Coordinating Board meeting the Stop TB Partnership to follow for revising the current on 14 – 15 October in Johannesburg, Coordinating Board support model for MDR-TB South Africa, the Board reviewed on 11 November in Berlin, management scale-up in countries. the response to the TB/HIV Germany, the Board recognized It also mandated the Global the work of the MDR-TB Working Laboratory Initiative and the New epidemic and requested that the Group and endorsed the proposed Diagnostics Working Group to Stop TB Partnership Working shift from project management develop a strategy on how best Group on TB/HIV and UNAIDS to integration of MDR-TB to encourage rapid, timely and develop an implementation plan management into national TB optimal uptake by countries of based on the memorandum programmes, with a view to new diagnostic tools. of understanding. achieving universal access.
Governance 13
%
3.3
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Ministry of Health Ministryof
Governmental Agency ( Agency Governmental © G. Sharma, Project Axshya, The Union India Union The Axshya, Project Sharma, G. ©
W IE V ER V O
RTNER A Partner Overview In 2010 the Stop TB Partnership began analysis work to better understand its partners. The majority of partners are organizations,civil society including nongovernmental organizations (NGOs),community-based organizations and faith-based organizations.The Partnership conducted a study on these organizations whichrevealed that our civil society partners are based mainly andin Africa South-East Asia and work on Advocacy. Communication and Social Mobilization, TB health-care services and technical assistance.
P EMENT G A G EN
ARTNER
PARTNER ENGAGEMENT P
14 Our largest partner group is NGOs
Figure 1 Breakdown of partners of the Stop TB Partnership, 2010 Academic
) )
/ National
Research Institution Charitable International
/ Philanthropic Foundation
Others
UN System Organization/Specialized Agency
Patient Activist Group (
Patient Activist Group (
9.8 %
%
% 5.0 %
% 0.6
Corporate Sector ( 1.7 NGO – National TB 0.3 2.9
% % Health 8.1
) 7.0 Corporate Sector ( %
Non-Health ) 2.1 % Faith-Based Organization ( FBO ) 2.1 % Governmental Agency ( Donor ) 0.6 % 17.1 % NGO – National Health ) 3.3 % Ministry of Health Governmental Agency (
3.4 % )
Governmental Agency % ( National TB Programme 0.8 % ) 0.1 % Other 0.1 % 0.6
Governmental Agency ( % 3.9 Intergovernmental Organization
International Health Partnership % 5.4 National Stop TB Partnership % 22.9
2.1
%
NGO – International Development NGO – National Development
NGO – International Health
NGO – International TB
Partner Overview PARTNER ENGAGEMENT 15 PARTNERING INITIATIVES TO STOP TB AT THE COUNTRY LEVEL
In 2010, country-level efforts In 2010 assistance was provided The WHO Regional Office for the focused on strengthening the to countries in three areas: Eastern Mediterranean assisted partnering process to deliver eight countries to set up a • to identify resources that each partnering initiative. Consultants better TB programmes and meet partner can contribute to were trained in partnering as the goals set out in the Global TB prevention and control part of a workshop on providing Plan to Stop TB 2011 – 2015. in the country; consistent and good-quality Country-level partnering brings • to develop a single national country-level technical assistance together organizations from TB plan, with each partner on the Stop TB Strategy. different sectors of society, contributing its core Communications with current competencies and obtaining including national TB programmes, national stop TB partnerships support for its role; civil society organizations and were maintained on a regular basis private-sector companies, to • to identify partners’ roles and through an electronic mailing list agree roles and responsibilities responsibilities and mobilize and a dedicated web site. Focal in delivering a shared operational resources jointly to implement points from national partnerships plan to combat TB. At the end of a coherent national TB plan. met in an exchange market at 2010 there were 32 country-level the International Conference of partnerships, 12 of which are The Stop TB Partnership issued the Union against Tuberculosis in high-burden countries. guidance on these processes and and Lung Diseases to share continued to update the guidance experiences, discuss challenges throughout the year based on and find solutions. A session on experiences in countries. The partnering initiatives to stop TB Partnership also provided technical was organized in the context of assistance, both in country and by the subgroup on ACSM at the correspondence, to Kenya, Nigeria, country level to illustrate Swaziland and India. different experiences.
We currently have 32 12 country level of which are in high- partnerships burden countries.
16 PARTNER ENGAGEMENT Partnering Initiatives to Stop TB at the Country Level Partner best practices: Examples from the field
Private sector: Becton, (FIND) entered into a pricing BD’s ongoing awareness and Dickinson and Company agreement that dramatically advocacy efforts begin at home expanded liquid culture testing with regular educational activities Becton, Dickinson and Company in areas of the world severely for associates including a robust (BD), a leading medical technology impacted by TB. To date, more than intranet site and World TB Day company, is committed to 13.5 million liquid culture tests have events. BD also helps raise addressing TB around the world. been administrated in 45 countries awareness worldwide through the BD deploys a strategy to fight TB heavily burdened by TB as a direct support of photography exhibits that includes increasing access to result of this agreement. that illustrate the problem of TB vital technologies, strengthening and the efforts in place to address BD helps to improve laboratory laboratory systems through the disease. Finally, BD executives services through training and technical assistance and general regularly participate in top technical assistance. For example, awareness and advocacy. global health and TB events and BD associates helped conduct conferences around the world. BD’s TB diagnostics utilise comprehensive courses on liquid culture, which is faster, TB control and safe laboratory more accurate and more practices in sub-Saharan Africa and comprehensive than conventional Southeast Asia. BD also worked approaches. Liquid culture is health officials in Uganda and particularly valuable in its ability Ethiopia to use Global Positioning to not only detect drug-resistant System technology to ensure that TB, but also to determine which TB specimens arrive safely and drugs can be used to treat the promptly at reference labs for patient. BD and the Foundation processing and results return for Innovative New Diagnostics to patients in a timely fashion. © BD
Partner Best Practices PARTNER ENGAGEMENT 17 Nongovernmental organization: KNCV Tuberculosis Foundation
KNCV Tuberculosis Foundation is a implementation of Global Fund center of expertise for TB control and grants in Zambia, Sierra Leone, a medical development organization. Liberia, Angola, Malawi, Rwanda, Committed to a world free of TB, Ghana, Tanzania Lesotho, KNCV works both in the Netherlands Mozambique, Indonesia, Tajikistan, and in around 40 countries Dominican Republic and Moldova. worldwide, providing technical assistance, advisory services, KNCV also provided support to training programmes capacity Global Drug Facility and Green building, as well as epidemiological Light Committee missions to and operational research. Swaziland, Liberia, Tanzania, Namibia, Zambia, Ethiopia, Highlights from 2010 include the Indonesia and Viet Nam. KNCV provision of technical assistance is represented on several Stop TB to successful Global Fund round Partnership workig groups. 10 applicants in Namibia, Ghana, As the chair of the ACSM Swaziland, Liberia and Indonesia sub-working group, KNCV and Ethiopia. In addition, with played a key role in the launch of the support of funds that were Advocacy, communication and provided through the TB Technical social mobilization for TB control: Assistance Mechanism (TB collection of country-level good TEAM), KNCV supported the practices in November.
18 PARTNER ENGAGEMENT Partner Best Practices A Stop TB Partnership TB and Human Rights Task Force was established in 2010, with the secretariat provided by WHO and UNAIDS. The task force includes: human rights legal experts, health and human rights advocates, representatives of vulnerable groups and major partner institutions also working on health and human rights.
National Stop TB Partnership: Swaziland
In Swaziland, which has the The Swaziland Stop TB Partnership The result are impressive. highest incidence of TB in the was set up to improve coordination In November 2010, the NTP world, an estimated 40% of and improve services. Following reported that nine community patients receive their health care a mapping exercise, all partners based organizations are now services through faith-based now have a shared five-year supporting delivery of TB services organizations, community strategic plan for TB which to an additional 3 000 patients. based organizations and identifies roles and responsibilities The NTP has also reported an nongovernmental organizations. for each partner in each area of improvement in TB outcomes. However, the TB control efforts the country. The TB case detection rate has of these organizations have not improved from 43% in 2006 to 70% always been well coordinated with currently. Similarly, treatments those of the National Tuberculosis success rate improved from Programme (NTP). 47% to 68%.
In Swaziland, nine to an additional community based organizations are supporting TB 3 000 service delivery patients
Partner Best Practices PARTNER ENGAGEMENT 19 Challenge Facility for Civil Society
The Stop TB Partnership’s Challenge Facility for Civil Society (CFCS) is a funding mechanism that provides grants to community-based organizations engaged in advocacy and social mobilization to raise awareness and empower communities to become part of the solution in the fight against TB.
In 2010, CFCS awarded a third These activities aim to increase the round of grants worth between number of people in communities US$ 5 000 and US$ 20 000 to seeking health care at an early 22 civil society organizations in stage, to reduce the rate at which 16 countries. These grants supported patients default on their treatment, various community-level activities, and to increase contact tracing. including public forums, door- to-door outreach, distribution of The call for proposals for the CFCS communication materials, reduction fourth round was announced in of stigma in the workplace, and October. This round was open enhancing support from local to Russian-language proposals leaders and women’s groups. for the first time, which permitted submissions from organizations in eastern Europe and central Asia.
20 Challenge Facility for Civil Society Good practice examples from CFCS grantees
• R aising awareness: • E ffective advocacy: • Improving health: In Ghana, Integrated Development CFCS grantees help to shape local Communities in Côte d’Ivoire in Focus developed TB education policies by advocating for TB to be have made significant headway sessions for TB patients, placed on the political and social in the fight against TB. Stop TB community volunteers and local agenda. The Ukrainians Against Bouaké provided much-needed stakeholders who returned to Tuberculosis Foundation prepared nutritional and financial support educate communities and raise and sent regulatory proposals and temporary accommodation awareness. Activities took place to the Ukrainian Government on during treatment to individuals in schools, churches, community the improvement of palliative and most in need. Combined centres and football parks and hospice care for people with TB. with large-scale advocacy, from house to house. community events and education for community volunteers and other NGOs, this work has increased the detection of TB cases three-fold.
Good Practice Examples from CFCS Grantees Challenge Facility for Civil Society 21
The TB REACH initiative is supported by a grant to the Stop TB Partnership by the Canadian Agency. Development International In the first wave of funding TB REACH has drawn the attention of partners to address the issue of TB case detection, especially among poor and vulnerable people. It has stimulated new ideas and the development of innovative approaches for TB case detection. Less than 9 months after TB REACH was launched, 29 projects were established and 50% of the funding was allocated. Encouraged by the response to the first call, TB REACH announced a second call for proposals in December 2010. to introduce newer diagnostic tools, to implement contact investigation, to develop public–private partnerships, to provide financial incentives for promoting early diagnosis, and to use mobile phone technology to improve access to care.
• • •
. TB of over US$ 126 million. 19 countries for funding under Wave 1. The total amount committed through Wave 1 was US$ 18.4 million. The 30 projects together aim to detect and treat more than 40 000 additional new cases of TB. The first call for proposals in January resulted in an overwhelming response. with a total requested amount The Proposal Review Committee approved 30 projects in TB REACH received 192 proposals, proposals, 192 received REACH TB Projects started inaimed 2010 to intensify TB case-finding among people living with to HIV, screen population vulnerable and high-risk groups, to provide enhanced TB diagnostic services, to expand the laboratory network,
gives an overview of the Wave 1 funding from TB REACH. • • • The fast-track funding mechanism is committed to getting funds to projects with a very short turnaround time. As suggested by its name, TB REACH focuses on reaching vulnerable and poor people and people with limited or no access to TB services. Figure 2 was launched on 25 January to H AC RE case detection, reduced transmission, improved drug-resistant forms of TB encourage the development of innovative techniques, interventions and activities that result in increased TB outcomes, and prevention of the emergence of REACH
TB
TB REACH 22 Figure 2 TB REACH Wave 1 funding
Number of applications Number of approved projects with a national TB programme 192 as principle recipient Number of approved projects 7 30 Number of approved projects with a civil society organization/ Number of countries with approved grants NGO as principle recipient 19 20 Total approved funds Number of approved projects with a government agency other than a national TB programme as US$ 18 447 870 principle recipient 3 Number of additional cases to be detected 41 255 Figure 3 19 countries with 30 TB REACH Wave 1 projects * This is a graphic representation of a WHO map.
2 Afghanistan 4 Pakistan Nepal
2 Lao People’s Yemen Democratic Republic Sudan Burkina Faso 2 Nigeria Ethiopia
Somalia Benin 2 2 4 Uganda Kenya Democratic Rwanda Republic of The Congo United Republic of Tanzania
Zambia
Zambabwe
Lesetho
TB REACH 23 Figure 4 TB REACH grants, by intervention*
18 Contact investigation
Intensified case finding among 9 people living with HIV
4 Screening clinical risk groups
20 Screening targeted populations
9 Prisons
22 Laboratory interventions
11 Public-private mix
Advocacy, communication 22 and social mobilization
13 Other
* Note that most projects have multiple interventions, so the total number of interventions is more than the total number of projects.
24 TB REACH Two examples of different TB REACH approaches are described here:
• R apid TB testing in a rural region of the • U se of mobile phones and financial incentives United Republic of Tanzania: to boost case detection in Pakistan: A collaboration between the Tanzanian Ministry In Karachi, Pakistan, the Indus Hospital has of Health and the University of Munich is reported a dramatic increase in case-detection implementing an innovative TB REACH project in rates following the start of a new programme the predominantly rural Mbeya Region of the United that uses mobile phone technology and financial Republic of Tanzania. Inhabitants of the region face incentives to find people with TB. Under the barriers in accessing TB care due to inadequate programme, family doctors and community health capacity of the health system. To improve access workers are rewarded for screening people and to care, the project introduced a mobile diagnostic referring people suspected of having TB to and treatment centre for TB and HIV. This van is a TB centres. The incentive scheme operates using laboratory in the daytime but serves as a cinema mobile banking facilities. Doctors and health in the evening, showing educational films about workers report their activities using their mobile TB and HIV. Diagnosis of TB in the van is carried phones on the Indus Hospital TB REACH mobile out using a revolutionary rapid automated test data collection system and receive a text message called Xpert MTB/RIF. This test can diagnose telling them how many cases they have helped to substantial numbers of people with TB who would detect. At the end of each month, these data are otherwise not be picked up by traditional tests used to calculate the incentive earned by each such as sputum microscopy. The project has also person. The incentives are then transferred to their introduced Xpert MTB/RIF machines in a few health mobile banking accounts. centres and prisons in the region. The project aims to detect 1 350 additional people with TB during the first year of implementation.
TB REACH 25
All four countries have a high burden of TB, with an increasing threat of drug resistance. In July, the Stop TB Partnership had a strong presence at the International AIDS Conference, with a display booth in the exhibition hall and several key events. On the eve of the conference, a satellite symposium on TB/HIV coinfection in eastern Europe and central Asia took place at the Reed Messe. Later, a group that had marched in Vienna in June to raise awareness about TB/HIV marched through the conference centre before a special lunchtime session, “No More People Living with HIV Dying from TB”. This session was chaired by Republic of Tanzania and Uganda to create a regional network of 25 public health laboratories. Dr Michel Kazatchkine, Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria. Featured speakers were Sidibé, Michel Mr Sampaio; Jorge Dr Executive Director, UNAIDS; Dr Marcos Espinal, Executive Secretary, Stop TB Partnership; and Mr Timur Abdullaev, a human rights lawyer from Uzbekistan who is living with HIV and currently undergoing TB treatment. cal TB iti t l s in po ent to the ent the to g m aga The Innovate to Eliminate Tuberculosis Symposium took place on March24 at the European Parliament in Brussels. The event was co-organized by the TB Vaccine Initiative, MEP Francoise Grossetête and the European Parliament Working Group on Innovation, Access to Medicines and Poverty-related Diseases. Dr Jorge Sampaio, the United Nations (UN) Secretary-General’s Special Envoy to Stop TB, called on Europe to make a turning2010 point in the fight against TB. Specifically, Dr Sampaio called for increased funding for TB research; support for programmes focused on MDR-TB and extensively drug-resistant TB (XDR-TB) in neighbouring countries with a high level of drug resistance; and creation of a TB think tank to bring together key stakeholders. In his remarks at the opening the of Ninth Session the of UN Permanent Forum on Indigenous Issues in April UN Secretary-Generalin New York, Ban Ki-moon special drew attention to the burden of TB among indigenous peoples. Board of the Bank’s World In May, Executive Directors announced that it would provide US$ million 63.7 Rwanda, Kenya, to the United it urin ht mm c g Securing Political Commitment to the Fight Against TB o
In 2010, efforts focussed on high-level advocacy to secure political political secure to advocacy high-level on focussed efforts 2010, In TB Stop of impact the increasing TB, on commitment and leadership a stronger introducing and meetings Board Coordinating Partnership sector. private the for role Se c fi
Political advocacy
tical advocacy Poli 26 The Stop TB Partnership Coordinating Board as a platform for advocacy
The 18th Meeting of the Stop agreement between UNAIDS included high-level dialogue with TB Partnership Coordinating and the Stop TB Partnership, four ministers of health. There Board took place on 4 – 5 May in Dr Aaron Motsoaledi, Minister was a particular focus on the Hanoi, Viet Nam. At the meeting’s of Health for South Africa, cross-border dimensions of TB, opening, Mr Nguyen Thien Nhan, announced a new campaign TB/HIV and MDR-TB in southern Deputy Prime Minister of Viet that will seek to mobilize Africa and a decision to initiate Nam, described the Partnership 15 million South Africans – a third planning of a ministerial forum as “unique” and praised it for of the country’s total population on TB and the mining industry in bringing together a wide variety of – to receive HIV testing and Southern Africa. The ministers of stakeholders in the fight against TB. counselling by June 2011. health of the United Republic of “This meeting is of significant Tanzania, South Africa, Lesotho importance for TB control in In October 2010 the Stop TB and Swaziland further agreed to Viet Nam, and supports our Partnership Coordinating form a ministerial group of TB National TB Programme’s efforts,” Board meeting was held in champions to be deployed at he said. In anticipation of an Johannesburg, South Africa and forums and high-level missions.
Left to right: Rifat Atun, Chair of the Stop TB Partnership Coordinating Board, Dr Aaron Motsoaledi, Minister of Health of South Africa, Dr Stella Anyangwe, WHO Representative for South Africa.
The Stop TB Partnership Coordinating Board as a Platform for Advocacy Political advocacy 27 Left: John Tedstrom, President and CEO of the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria. Right: Rifat Atun, Chair of the Stop TB Partnership Coordinating Board.
Engaging with the private sector
Top multinational business and practices and how the private the donation of 250 000 adult short- non-profit-making leaders met sector can have the greatest course TB treatments to the United in New York on 23 March to impact. John Tedstrom, President Republic of Tanzania through the discuss the role of the private and Chief Executive Officer of Stop TB Partnership’s GDF. sector in curbing the spread GBC, issued an urgent “call to of TB. Speakers from Becton action” to the business community. For the first time, GBC held a forum Dickinson and Company, Pfizer on TB and TB/HIV in South Africa in Inc, the Global Business Coalition In May, Dr Klaus M Leisinger, October. The South African Minister on HIV/AIDS, Tuberculosis and President and Managing Director of Social Development and the Chief Malaria (GBC), the Aeras Global of the Novartis Foundation for Executive of AngloGold addressed TB Vaccine Foundation and the Sustainable Development, and the forum; John Tedstrom joined the Stop TB Partnership highlighted Dr Hiro Nakatani, WHO Assistant high-level panel for the launch of the the unique assets that businesses Director-General, signed a Global Plan to Stop TB 2011 – 2015. can bring to the TB fight, best memorandum of understanding for
28 Political advocacy Engaging with the Private Sector Coordinating global advocacy
In November the Advocacy Advisory Committee had its annual meeting along with the annual meeting of the Advocacy Network. They provided inputs to the 2011 Advocacy Framework and drafted a detailed letter to the Chair of the Coordinating Board highlighting the need to expand targeted resource mobilization efforts, for example in emerging market economies.
Former Executive Secretary of the Stop TB Partnership, Dr Marcos Espinal (left), with Michel Sidibé, Executive Director of UNAIDS.
Coordinating Global Advocacy Political advocacy 29 UN Secretary-General’s Special Envoy to Stop Tuberculosis
30 UN Secretary-General’s Special Envoy to Stop TB In 2010 Dr Jorge Sampaio engaged in political advocacy on high-level missions and at events. In addition to the activities described in the political advocacy section, highlights included: Advocacy in the Middle East
Dr Sampaio visited Jordan to draw is run by a nongovernmental people in TB care and encouraged attention to TB as a serious public organization (NGO) with the help them to continue treatment. health problem in many countries of the Jordanian Government and Dr Sampaio also had the opportunity of the region and the Islamic world, receives patients for MDR-TB to meet with HRH Prince Ali Ben while highlighting Jordan’s role as treatment from Jordan and Hussein and other high-level a leader in the fight against TB. neighbouring countries, including Jordanian personalities: Dr Sampaio The mission was organized under Iraq, Sudan, the Syrian Arab congratulated Jordan on its the auspices of Prime Minister Republic and Yemen. Dr Sampaio significant progress on TB and Samir Al Rifaai, in coordination with – accompanied by officials from MDR-TB, while emphasising that various organizations, including the the National Tuberculosis Control TB is a significant public health National Tuberculosis Programme Programme, WHO and Stop and development concern in many and WHO. Dr Sampaio visited Tuberculosis Ambassador Muslim countries. the Alnoor Sanatorium, which Ms Rania Ismail – spoke with
Launch of Continued the Global efforts to Plan to Stop address TB 2011-15 the TB/HIV
Dr Sampaio was a keynote speaker at the World Health Summit in Berlin in October co-epidemics for the launch of the Global Plan to Stop TB In July, Dr Sampaio addressed the audience of the XVIII 2011 – 15. The annual conference of the M8 International AIDS Conference in Vienna in a special session Alliance of Academic Health Centers and on TB/HIV. The session, chaired by Michel Kazatchkine, Medical Universities together with the National also featured Marcos Espinal, Michel Sidibé and Academies offered a unique opportunity to Timur Abdullaev. Dr Sampaio’s engagement with TB/HIV address leaders from academia, politics, industry continued throughout the year in light of the UN General and civil society on the need to scale up the Assembly Special Session (UNGASS) on AIDS planned fight against TB. Dr Sampaio made a similar in June 2011. He had a series of high-level advocacy appeal to the media attending the closing press meetings, including with the WHO Director General conference of the Summit. and a UNAIDS executive to advocate for TB/HIV to be included in the agenda of UNGASS.
UN Secretary-General’s Special Envoy to Stop TB 31 Communications, celebrities and events Goodwill Ambassadors against Tuberculosis
Craig David
British singer–songwriter Craig David Centre on Communications – into six organized by the UN Foundation is lending his voice – which has fast-paced, informative and in partnership with Mashable and helped him sell more than entertaining video pieces, which the 92nd Street Y (a well-known 13 million albums in more than were launched in the spring and cultural and community centre 20 countries – to the global summer and made available in Manhattan). He also delivered fight against TB. Craig marked on YouTube. his message on TB at high-level his appointment as Goodwill Through 2010, Craig delivered events attended by dignitaries Ambassador against TB on World messages on TB via his own and celebrities, including Queen TB Day by participating in events at Facebook page and Twitter. Rania of Jordan, Bob Geldof, the UN Headquarters in New York. In September he made a second Tommy Hilfiger and Ted Turner. His aim is to raise awareness mission, this time to New York on In November, Craig David about TB among his millions the occasion of the UN High-Level discussed TB in an interview of fans worldwide. “Music is a Plenary Meeting on the Millennium for Riz Khan’s One on One universal language. I believe that Development Goals (MDG Summit). show, broadcast on Al Jazeera through people’s love of music There he talked about TB English to more than 200 million we can increase knowledge and with journalists, bloggers and understanding and support people civil society at the UN Week households in 82 countries affected by TB. I hope that people Digital Media Lounge, an event around the world. who feel inspired by my music will also feel moved by what I have to say about TB,” Craig says.
To prepare for his new role, Craig travelled to Cape Town, South Africa in early March to learn more about TB. Far from his world of packed concert halls, he visited communities hit hard by TB, schools and a research centre. Craig’s voyage of discovery was documented by a film crew, and the material was transformed by Fabrica – Benetton’s Research
32 Communications, celebrities and events Goodwill Ambassadors against Tuberculosis Luís Figo Anna Cataldi
Luís Figo joined Dr Jorge Sampaio Author and journalist Anna Cataldi on a visit to Jordan in April. Their continued her strong focus on TB objective was to draw attention in the eastern Mediterranean region, to TB as a serious public health visiting the Islamic Republic of Iran problem in many countries of and Pakistan in April. the region and the Islamic world, In Pakistan her aim was to while highlighting Jordan’s role as invigorate public awareness a leader in the fight against TB. initiatives centred on MDR-TB, since the country ranks sixth Figo visited the SOS Children’s among the 27 most affected Village, where children performed countries. In the Islamic Republic traditional dances and he read of Iran she participated in core aloud from Luís Figo and the World discussions on enhancing TB Tuberculosis Cup, a comic book in control by strengthening public– which he is featured as the main private partnerships, broadening character. He and Dr Sampaio also collaboration with neighbouring visited the Alnoor Sanatorium. countries, and working closely with At the Petra Stadium at Amman’s UN agencies to address issues Sports City, Figo met members of World Cup in South Africa. The related to TB among displaced the Jordan national football team event celebrated the power of persons. She also visited people and youth team and watched football for social change, with with MDR-TB and women serving a match between a Stop TB 32 teams of young people from as community volunteers for TB. Partnership team and a rival team. disadvantaged communities around Ms Cataldi, who completed her Figo praised the players for their the world gathering for a festival term as a Stop TB Ambassador in team spirit. “This is what we need to of football, culture, education and 2010, was honoured at a ceremony use in our fight against tuberculosis entertainment. TB was discussed on the eve of the World Conference and beat it with wonderful team in the context of training workshops of the International Union Against players like you all,” he said. on HIV/AIDS, and teens from Tuberculosis and Lung Disease in The comic book featuring Figo several countries heavily Berlin in November. was also presented at the affected by TB participated in Football for Hope Festival 2010, an interactive information session an official event of the 2010 FIFA on TB prevention and treatment.
Goodwill Ambassadors against Tuberculosis Communications, celebrities and events 33 Awards
Kochon Prize
Dr Armand Van Deun was the Dr Van Deun is an international recipient of the 2010 Kochon Prize, leader on improving laboratory which is awarded annually testing for TB. His efforts have to people, institutions and had an impact on the quality of organizations that have made a work performed by laboratory highly significant contribution to technologists around the world, combating TB. The Prize is fully resulting in thousands of lives funded by the Kochon Foundation, saved through diagnosis of TB a non-profit foundation registered followed by effective treatment. in the Republic of Korea.
Stop TB Partnership Award for Excellence in Reporting on TB
This award, which is supported consumptive”), another personal series “The forgotten disease”, by the Lilly MDR-TB Partnership, account of battling TB, which was published in the Winnepeg Free recognises outstanding reporting published in Polityka, a weekly news Press, draws attention to the and commentary in print and on magazine; Ms Biernat received ever-present toll of TB in Canada’s the web that materially increases US$ 2 000 in prize money. most isolated rural communities. the public’s knowledge and The third prize winner, who Jenna Sloan and Kate Wighton of understanding of TB and MDR-TB received an award of US$ 1 000, the United Kingdom shared the in countries affected by the disease. is Sabina Aliyeva of Azerbaijan. third prize of US$ 1 000 for their Her article, “Палочка Коха, article “Singer joins campaign to Winners of the prize were recognised уносящая жизни” (“Koch bacillus wipe out TB across the globe”, at an event held on the eve of the takes lives”), was published in the which appeared in The Sun and World Conference of the International newspaper Каспий and recounts chronicles the travels in South Union Against Tuberculosis and Lung the life of the widow of a man who Africa of Craig David, Goodwill Disease in Berlin. died of MDR-TB. Ambassador against TB.
The first prize winner in the low- Two journalists tied for the first and middle-income category, who prize in the high-income category, received an award of US$ 3 000, each receiving US$ 2 500 in prize was Lungi Langa of South Africa. money (an equal share of the first Her article “I didn’t think I’d have and second prizes combined). TB”, published in The Daily News, Andrew Jack’s “Diagnosis: Hope”, recounts her personal saga of published in the Financial Times confronting the disease. Anna (United Kingdom of Great Britain Biernat of Poland took second and Northern Ireland), points to prize for her article “Zpamietnika the troubling lack of funding for suchotnika” (“The diary of a TB research. Jen Skerrit’s six-part
34 Communications, celebrities and events Awards Images to Stop Tuberculosis Photo Award
The Images to Stop Tuberculosis On World TB Day 2010, the portfolio, which depicts the Photo Award seeks to produce reportage of David Rochkind, stigma and hardships faced by a comprehensive body of the winner of the 2009 award, people with MDR-TB and XDR-TB photographic work on TB to be was released worldwide. The in central Asia. Mr Friedman used for advocacy purposes. reportage, featuring TB in the received a grant of US$ 5 000 to Every year, an international jury slums of Mumbai, was featured produce a photographic essay on selects a photographer who will by major online media channels, TB/HIV in Ukraine and US$ 5 000 receive a grant to produce a including BBC News. in prize money. photographic reportage depicting TB. The award is supported by In addition, in October the the Lilly MDR-TB Partnership and winner of the 2010 award was is developed with the guidance of announced. Photographer world-renowned photo-journalist Misha Friedman was selected Gary Knight. from among 33 entries for his
Awards Communications, celebrities and events 35 Global communications
Web/social media
The Stop TB Partnership website, social media. The Stop TB www.stoptb.org, drew an Partnership Flickr site received unprecedented audience in 2010, over 16 000 views between its with nearly 8 million visits – creation in March 2010 and a 36% increase over 2009. 1 January 2011; in the same The Stop TB Partnership timeframe, the newly established Secretariat also continued and Stop TB Partnership YouTube expanded its engagement into channel had 27 560 upload views.
TB/HIV in the spotlight at the International AIDS Conference
At the XVIII International AIDS The marchers alternated between Conference in Vienna a bold coughing into handkerchiefs and protest march called for “no chanting the slogans “When you more deaths from TB in people cough, when you sneeze, cover living with HIV”. The TB cough-in/ your mouth to stop TB!” and “Stop coffin march began in the Global TB!” One of the two black coffins Village at the conference at noon. bore the message “Saved from Scores of people assembled, HIV, but died from tuberculosis”. with T-shirts, placards, cardboard coffins, vuvuzelas, drums, The marchers wove their way banners and special Stop TB through the Global Village, swelling handkerchiefs, distributed through their ranks with new volunteers the conference by the Stop TB as they crossed the conference Partnership Secretariat. centre, finally landing in a session room where a lunchtime plenary session on TB/HIV was about to begin. The session, chaired by Michel Kazatchkine, featured Dr Jorge Sampaio, Marcos Espinal, Michel Sidibé and Timur Abdullaev.
36 Communications, celebrities and events Global Communications World TB Day: On the Move Against Tuberculosis
In 2010 the Stop TB Partnership • B angladesh: The Chest and materials about TB along their Secretariat launched a new 2-year Heart Association of Bangladesh route. At a ceremony attended campaign, On the Move Against organized a rally against TB by 850 people, including high- Tuberculosis, built on the theme at the National Institute of level government officials, the of innovation. The campaign Diseases of the Chest and Yaam Wekré Association was focuses on individuals around the Hospital, Dhaka, in which some honoured for its efforts in TB world who have found new ways 300 doctors, nurses and other care. A separate awareness- to stop TB and can serve as an health workers participated. raising event was held at the inspiration to others. The idea is Later an additional 400 health central prison in Ouagadougou to recognise people who have workers from around the country and attended by 100 inmates. introduced innovations in a variety attended a scientific seminar of settings. aimed at raising awareness of • Japan: The Yomiuri, the TB. Journalists were also invited, newspaper with the highest The World TB Day blog, and the events were widely circulation in the world www.worldtbday.org, was covered in the media. (10 million readers), featured a relaunched as a vehicle through story about Masanori Naruse, which partners around the world • B urkina Faso: Koudougou, a 35-year-old former MDR-TB announced news, reported on a city located 100 km from patient who now serves as a events, and shared posters, the capital, was selected as TB advocate on behalf of the photos, videos and other materials the site for this year’s national Japanese Anti-Tuberculosis relating to the campaign. commemoration because it has Association. a problem – a poor rate of TB Here are some highlights from detection and cure. Events • M exico: World TB Day was World TB Day events around the began with a 124 km bicycle commemorated in Tijuana, world, which were featured on tour around the region, with Baja California though a series the blog: cyclists distributing educational of events organized by the Tuberculosis, HIV/AIDS and Diabetes programmes from Heath Jurisdiction No. II and Solucion TB, an initiative of Project Concern International. Tijuana, situated on the United States – Mexico border adjacent to its sister city of San Diego, is the most transited border city in the world. To raise awareness about TB and the need for prompt treatment and continuity of care, affected individuals, staff and interns from the local rehabilitation centre distributed educational materials and gave community talks.
Global Communications Communications, celebrities and events 37 Working groups: main achievements
The Stop TB Partnership’s • New TB Diagnostics; working groups serve • DOTS Expansion; to ensure that action to • MDR-TB; combat TB makes the best possible use of existing • TB and HIV; resources, skills and • New TB Drugs; funding. Working groups • Global Laboratory are organized around Initiative (GLI); specific areas of activity • New TB Vaccines.
In 2010 all working groups played a key role in the development of the Global Plan to Stop TB 2011–2015. Other highlights from the year include the following: New Diagnostics Working Group
This group seeks to implement research, advocacy and operational activities in pursuit of the development of TB diagnostic tools.
The group contributed to the development of WHO policy guidance for commercial serological tests and for use of commercial Interferon Gamma-Release Assays (IGRA) in low- and middle-income countries.
The TB Diagnostics and Poverty Subgroup developed documentation on conducting impact assessments. The Diagnostics for Latent TB Infection Subgroup optimized a web-based algorithm to assist the interpretation of tuberculin skin test and IGRA results.
38 Working groups New Diagnostics Working Group DOTS Expansion Working Group
The DOTS Expansion Working Group aims to expand access to TB diagnosis and treatment. It is an arrangement between WHO, major financial and technical partners, national TB control programmes from 22 high-burden countries and community representatives.
In 2010 the working group, led by WHO and working with the Global Laboratory Initiative, MDR-TB Working Group and TB-HIV Working Group, developed a diagnostic algorithm on the use of a new rapid diagnostic test, Xpert MTB/RIF.
Childhood TB Subgroup Human Resource Development The Stop TB Partnership In 2010 this subgroup contributed for TB Subgroup Secretariat, supported by to the development of new policy In 2010 a core subgroup was subgroup members, organized guidelines on the treatment of TB established with representatives an international ACSM training in children and a desktop guide for of key Stop TB Partnership session for a group of TB consultants from different the diagnosis and management of partners and partners from the agencies and WHO regions. TB in children. field of human resources for health. An interim chairperson Introducing New Approaches The subgroup members provided was elected. and Tools Subgroup technical assistance for TB programmes in many countries, The subgroup has promoted and Following its first meeting, this developing national guidelines, supported the development of subgroup has started activities focused on increased TB case implementing national training strategic human resources plans detection in five countries. workshops and leading advocacy for the implementation of the Field tests focus on links with efforts to push for new diagnostics Stop TB Strategy and the need large hospitals, TB contact for childhood TB. for close collaboration between national TB control programmes investigation, and TB screening in high-risk groups. Public–Private Mix for TB Care and departments of human and Control Subgroup resources for health in ministries The subgroup started to develop of health. The sixth meeting of this subgroup, an operational guide that compiles information on how to implement held in Istanbul, Turkey, focused on Advocacy, Communication and ways to expand the scale-up major new approaches and tools Social Mobilization Subgroup of public–private mix (PPM) recommended by WHO. In 2010 this subgroup launched programmes and address the global a collection of advocacy, deceleration of TB case detection. TB and Poverty Subgroup communication and social This subgroup organized a A PPM toolkit was launched at mobilization (ACSM) good regional workshop in New Delhi the Stop TB Symposium in Berlin, practices during the Stop TB on TB and poverty for national Germany. The toolkit is designed Symposium in Berlin. PATH, TB programme managers and to provide practical guidance on a member of the subgroup, other partners, which issued the engagement of all relevant care developed a training curriculum recommendations on ensuring providers in TB care and control. for planning ACSM interventions. equal access to TB services.
DOTS Expansion Working Group Working groups 39 MDR-TB Working Group
The MDR-TB Working Group, Research Subgroup GLC organized several courses which is managed and convened A symposium on research and and workshops. In Peru and India, by WHO’s Stop TB Department, innovation to address drug-resistant national and global consultants seeks to reduce human suffering TB was organized at the World were trained in drug management and mortality due to MDR-TB, Conference of the International and supply, infection control, through assistance to countries Union Against Tuberculosis and monitoring and reporting, and scaling in implementing the MDR-TB Lung Disease. up MDR-TB response plans. component of the Global Plan In Geneva, Switzerland, WHO staff to Stop TB. The subgroup organized a from country and regional offices workshop on designing studies In 2010 the group held a retreat learnt how to provide technical to investigate the risk factors for all major MDR-TB partners support to Member Countries on for drug-resistant TB. and agreed to produce a new MDR-TB. Training courses in Egypt framework for coordinating and Zimbabwe focused on planning Green Light the response to the MDR-TB and budgeting. Courses in Ukraine, Committee Subgroup epidemic. The first draft of the Kenya, Georgia and Ghana framework was endorsed by the The Green Light Committee (GLC) focused on drug management. Coordinating Board. The group approved 58 applications for the A workshop in Oman for Gulf also agreed to set up a task treatment of more than 40,000 Cooperation Council Countries force for engaging all health-care people with MDR-TB. More than resulted in all six attending providers in the response to the 12 000 people were enrolled countries preparing proposals MDR-TB epidemic. in treatment. for MDR-TB expansion plans.
40 Working groups MDR-TB Working Group TB/HIV Working Group
The TB/HIV Working Group, in the WHO European Region, support to a TB protest march which is managed by WHO’s was held in Vienna in July, prior calling for no more deaths from Stop TB Department, seeks to to the XVII International AIDS TB among people living with HIV. coordinate and monitor the global Conference. The latter brought In addition, the working group response to the HIV-associated together a broad range of 186 was instrumental in the signing of TB pandemic, while collecting and TB and HIV stakeholders from a memorandum of understanding sharing information and providing 37 countries, including those between the Stop TB Partnership advice. It has one subgroup on countries most affected by TB and UNAIDS that binds the two infection control. and HIV in the region. Both organizations to a common target meetings proposed solutions to of a 50% reduction in the number As part of the group’s role to issues and barriers particularly of people living with HIV who die define the research agenda relevant to the region such as from TB by 2015, compared with for TB/HIV, an annual HIV/TB prisons, MDR-TB, drug use, 2004 levels. research frontiers meeting was organized in collaboration with verticalisation of services and Infection Control Subgroup the Consortium to Respond overemphasis on hospitalization The third core group meeting was Effectively to the AIDS/TB of TB patients. The working held in Berlin in November, where Epidemic, affiliated with the group also provided capacity the Infection Control Subgroup’s 17th Conference on Retroviruses building of community groups strategic directions for the coming and Opportunistic Infections in and civil society representatives years were elaborated upon San Francisco, in February. to assist the regional TB/HIV with focus on the new fields of The working group started to revise response. The working group also collaboration, occupational health the priorities for HIV/TB research provided support for countries and general infection prevention and new guidance was published in the African and Asia Pacific and control. In addition, the group on priority research questions region catalysing the scaled up agreed to develop tools for TB for TB/HIV in HIV-prevalent and implementation of collaborative infection control monitoring and resource-limited settings. TB/HIV activities. evaluation at country and global The core group meeting was held The working group’s efforts levels, as well as a series of future in Almaty, Kazakhstan, in May and ensured that TB/HIV was put deliverables, essential to the next a regional working group meeting, firmly on the agenda at the XVII phase of scale-up of TB infection Accelerating the Implementation International AIDS Conference in control implementation worldwide. of Collaborative TB/HIV Activities July. The working group provided
TB/HIV Working Group Working groups 41 New Drugs Working Group
The purpose of this group is to between regulatory agencies and An internet campaign was launched ensure that scientists, academics, TB drug developers about the consisting of an improved dynamic pharmaceutical companies, approval process for new TB drugs. web site, a new blog page with donors, multilateral organizations more than 140 posts on the latest and patients work together to Concerted efforts to foster TB research and development accelerate the development of new interactions among group news, interactive online resource drugs for TB. It has four subgroups: members resulted in a collaborative tools and social media channels to Biology/Targets, Candidates, agreement on the drug candidate support advocacy and outreach on Critical Knowledge and Tools, TMC207 for susceptible TB, TB and new drugs. and Clinical Trials Capacity. advances in combination therapy testing, the completion of three The Biology/Targets Subgroup In 2010 the group cosponsored early phase clinical trials with two completed the first phase of their the Open Forum 4 in Addis Ababa, of the three trials targeting MDR-TB, project to have a comprehensive Ethiopia as part of a series of events and the completion of a late phase database of tuberculosis-specific aimed at increasing the dialogue trial for latent TB. targets and compounds.
Global Laboratory Initiative
GLI works closely with national TB The group developed and The GLI laboratory toolkit has programmes, NGOs, technical and conducted a training workshop for been expanded to include a financial partners, and WHO offices TB laboratory and non-laboratory roadmap for TB laboratory at the country and regional levels to consultants on Global Fund strengthening within national strengthen TB laboratory services. applications. Of 12 countries strategic laboratory plans, a WHO requesting GLI input, 9 were framework for implementing new In 2010 the working group successfully awarded Round TB diagnostics, and a technical contributed to a global consultation, 10 Global Fund grants. manual for first- and second-line led by WHO, on the Xpert MTB/RIF drug susceptibility testing. diagnostic test. A global consultation of the WHO-GLI TB Supranational The group completed laboratory Reference Laboratory Network assessments for 19 of the 27 (SRLN) was conducted. recipient countries under the All 27 MDR-TB priority countries EXPAND-TB Project. Following are now formally linked to the upgrades, training, policy SRLN, and several countries reform and the validation of new in the EXPAND-TB Project are technologies, eight countries in receiving SRLN technical support. this project are now routinely diagnosing people with MDR-TB.
42 Working groups New Drugs Working Group / Global Laboratory Initiative New Vaccines Working Group
The aim of this working group priorities for the next decade to be A meeting of the Task Force is to bring together international used as the basis for a blueprint on Innovative Approaches to groups with an interest in TB for TB vaccine development. TB Vaccine Development was vaccine development, with convened, which identified key the working group acting as a The working group provided a grant issues and unanswered research broker to promote synergy and to the South African Tuberculosis questions in the TB vaccine field. to accelerate identification and Vaccine Initiative to develop a The meeting resulted in a set of introduction of the most effective comic book, printed in Afrikaans, recommended strategies to address vaccination strategy. Xhosa and English, to communicate these critical issues and maintain information on TB vaccine clinical a robust TB vaccine pipeline. In 2010 the working group research and address common convened the Second Global questions and misunderstandings Forum on TB Vaccines in Tallinn, about TB vaccine clinical trials Estonia. The Forum identified in communities.
New Vaccines Working Group Working groups 43 TB Research Movement
The Stop TB Research Movement works to engage stakeholders in a collaborative and strategic effort to increase the scope, scale and speed of TB research. The two main objectives assigned to the Research Movement are:
• to provide leadership and The reports from both meetings advocacy to mobilize increased were used in the development of resources in support of a the research and development coherent and comprehensive section of the Global Plan to Stop global TB research agenda; TB 2011 – 15, which was the main focus for the Research Movement • to provide a forum for funders in 2010. and implementers of TB research to coordinate plans This update to the Global Plan and actions, to ensure that to Stop TB 2006 – 2015 includes research needs are addressed, sections on basic research and opportunities prioritised and operational research and revised gaps filled. sections on new diagnostics, drugs and vaccines, with set In March, in collaboration with activities and indicators for targets the National Institutes of Health, in research and development. the National Institute of Allergy and Infectious Diseases, and To coordinate input to the Global Treatment Action Group, the Plan, the Stop TB Partnership Stop TB Partnership held a held meetings with the working workshop focusing on priorities groups on new vaccines, new in fundamental research for diagnostics and new drugs the elimination of TB. This was in January and September. followed by a workshop in May on operational research.
44 TB Research Movement 45
M E TB T A The TA was carried Theout WHO, TA by Project The Union, RIT/JATA, KNCV Tuberculosis Hope, PATH, Foundation, German Leprosy and Relief Association, GIP ESTHER, Association Medecine Preventive and other consultants from TB The collaborative roster. TEAM’s planning encouraged TB TEAM by and the cooperation among TB TEAM partners resulted in provisionwell-coordinatedthat TA advantagetook the of comparative technical and/or regionalexpertise theof various partners. During 2010, TB TEAM assistedDuring 2010, with the coordination and planning more missionsof than 100 help to countries needs identify and TA plansproduce that budgeted TA support countries’ national TB plans. In addition, it supported 43 countries in developing proposals for Global grants. Fund grants27 were approved – a 63% success – raising rate more than US$ 1 billion for TBin 2010. The TB Technical Assistance Mechanism (TB TEAM), TEAM), (TB Mechanism Assistance Technical TB The a partnership mechanism managed by WHO’s Stop TB Department, works with National TB Programmes the improve to providers (TA) assistance technical and TB improve to order in TA of planning and coordination control and patient care. In addition, TB TEAM works to improve the performance of Global grants.Fund TBA TE M T Throughout 2010, GDF continued its he work to ensure the timely delivery of first and second-line anti-tuberculosis drugs
Glo and diagnostics at sustainable prices.
Despite challenging market conditions, GDF’s core procurement business grew strongly in 2010. Please see Annex II for full financial details. This equated to 2.3 million patient treatments and more than 12 000 MDR-TB patients enrolled under GLC projects. This brings the total number of first-line drug patient treatments delivered by GDF since
ba 2001 to 18.5 million.
l D l GDF grant funding
rug In 2010, through its grant service, GDF continued to provide first-line drugs to countries that were unable to secure the finances needed. These countries’ proposals were assessed by the GDF Technical Review Committee and approved by the Stop TB Partnership Coordinating Board. In summary: • 31 applications from 22 countries were approved;
F • 46 countries from five regions placed grant orders for first-line drugs. ac GDF DIRECT ili PROCUREMENT
t services
y y GDF direct procurement services allow clients to source anti-TB drugs through GDF, leveraging its knowledge of the TB drug market, purchasing capacity and logistics expertise. It provides an appropriate mechanism whereby clients use their own financial resources, or donor fund grants, to procure the drugs and diagnostics that they need.
GDF’s procurement services business grew strongly in 2010. The total value of orders placed in 2010 was US$ 87 million, up from US$ 48 million in 2009.
46 The Global Drug Facility GDF Grant Funding / GDF Direct Procurement Services Second- GDF line monitoring Drugs missions
In 2010, the Green Light Committee reviewed In addition to the procurement of first-line drugs, 58 applications from 44 countries requesting second-line drugs and diagnostics, GDF uses its approval for GDF procurement of second-line drugs, expertise to provide technical assistance in the form the applications funded by either governments or the of monitoring missions and supply chain management Global Fund. Fourteen countries placed grant orders workshops. In 2010, a total of 52 monitoring missions utilising funding from UNITAID pursuant to the MDR-TB were conducted in 52 countries. The objectives of Scale-Up Project, and more than 12 000 MDR-TB these missions are to validate stock levels, assess patients were enrolled under GLC projects. overstocking and stock-outs, assist with planning for future requirements, and highlight problems in the supply chain.
Second-line Drugs / GDF Monitoring Missions The Global Drug Facility 47 In 2010, a total of 52 monitoring missions were conducted in 52 countries.
GDF restructuring
During 2010, the Stop TB The reports recommended that Partnership Coordinating Board GDF be restructured to render commissioned the Boston it more efficient and effective. Consulting Group (BCG) to assess Moreover, GDF was requested the future direction of GDF and to address: provide an implementation and • organization and governance; restructuring plan. A report on the future direction was produced • performance management; in July and the restructuring plan • order management process; was provided in October. • market development; In addition to the BCG reports, WHO conducted an internal • reliance on donor funding/ audit of GDF and the report was sustainable models for the future; finalised November 2010. • effective provision of capacity building to countries by way of technical assistance; • communication strategies.
48 The Global Drug Facility GDF Restructuring GDF quality assurance
In July, GDF published its As a result of this harmonisation, • promotion of the use of latest quality assurance policy. combined expressions of interest quality-assured medicines The policy aims to ensure for TB manufacturers are now for TB control; harmonisation with the policies of issued every six months for review • reduced risk of a surge of MDR-TB two major multi-lateral financing by an expert review panel. due to poor-quality medicines; mechanisms (The Global Fund In addition GDF will use the same and UNITAID), as well as other key sampling and testing services as • quality supply to all countries, organizations (The Union, UNICEF, its partners and will conduct joint irrespective of the funding source; Médecins Sans Frontières). quality control testing. The objectives are to: • strengthened partnerships The anticipated benefits of this and collaboration with • ensure global consistency closer alignment are: technical partners. on quality standards set for procurement and supply of anti-TB • all patients will receive medicines and diagnostics items; quality-assured medicines • harmonise standards for the with the same recognized selection of medicines and international quality standards; manufacturers; • shared resources will increase • avoid duplication of effort. cost-effectiveness;
GDF Quality Assurance The Global Drug Facility 49 Resource Mobilization and Financial Management
Additional funding of more than For anti-TB drug procurement, In 2010, resource US$ 12 million was provided GDF received additional funds of mobilization efforts by the UK government’s US$ 1.2 million from USAID for development agency, DFID, for procurement for the Democratic of the Partnership drug procurement and technical Republic of the Congo; assistance to India’s Revised US$ 829 000 from WHO’s were intensified, National Tuberculosis Control Regional Office PAHO for Programme. As part of its long-term procurement for Brazil; as well resulting in agreement to support TB REACH, as US$ 342 000 in increased Partnership income the Partnership’s innovative contributions from the Kuwait and new initiative to increase Patients Helping Fund Society. rising by more than case detection among isolated Continued contributions from populations, the Canadian UNITAID to GDF for procurement US$ 16 million International Development Agency of diagnostics, second-line drugs gave US$ 19.7 million during the and paediatrics further supported over income year. Funding from the Centers for the efforts of the Partnership. Disease Control and Prevention received in 2009 increased to US$ 541 000 Of particular note, the online to US$ 110 million due to special funding of donation portal hosted by the US$ 350 000 for the Global UN Foundation (UNF) contributed based primarily Laboratory Initiative. Within US$ 96 000 in 2010. During the the framework of the current year, preparations for a further on increased memorandum of understanding, two-year amendment were contributions received from the launched to extend the current contributions from Global Fund were US$ 2.9 million arrangement with UNF into 2013. in support of the work of the core donors, Green Light Committee in as well as funds 41 countries. from new donors.
50 Resource Mobilization and Financial Management The online donation portal contributed US$ 96 000 in 2010.
Summary financial statements • Advocacy and Communications for the Stop TB Partnership as expenditures fell in 2010 to a whole and for GDF appear in US$ 1.7 million, a 33% decline Annexes I and II, respectively. from the preceding year due to Some key financial points have restructuring of the Advocacy, been noted during 2010: Communication and Social Mobilization team in which • Total income of the Secretariat certain activity and staff was US$ 110.3 million, a 18% positions and related costs were increase over 2009 when income relocated to the Partnership stood at US$ 93.8 million. Building team.
• Operating expenditure was The surplus income over US$ 82.4 million, considerably expenditure was US$ 27.8 million higher than 2009 when total (US$46.9 million in 2009), including expenditure was US$ 46.9 million. US$ 900 000 transferred to This increase reflects a rise in orders reserves. The majority of the placed by the Global Drug Facility surplus came as a result of funding and initial disbursements under for GDF from UNITAID of the first wave of TB REACH grants. US$ 14.0 million arriving in December 2010. A further 31% • Interest totalling US$ 950 000 of the surplus was attributed to was credited to the Stop TB specified funding for TB REACH. Partnership Trust Fund in 2010. These funds are scheduled for disbursement in 2011. • With the first wave of 30 grants awarded in 2010, TB REACH expenditures increased to US$ 10.4 million for the year. The total value of the first wave of grants was US$ 18 million.
Resource Mobilization and Financial Management 51 Annex I Stop TB Partnership Financial Management Report Summary Statement of Income and Expenditure for the year ending 31 December 2010 (all figures in US$ ‘000)
2009 2010 Voluntary contributions In cash Governments & their Agencies 56 844 66 676 Multilateral organizations 24 028 22 373 Foundations and others1 3 417 4 843 Sub-total 84 289 93 892 In-kind In-kind contribution for drugs (Novartis) 1 690 — Total voluntary contributions2 85 979 93 892
Interest income 4 094 950 Other income and adjustments WHO support & other income 440 56 Prior year adjustment3 3 351 15 352 Total income 93 864 110 250
Expenditure Partnership Building 12 993 14 455 Advocacy and Communication4 2 603 1 741 Global Drug Facility (GDF)5 28 300 52 049 TB REACH 74 10 417 General Management and Administration6 2 908 3 739 Total expenditure 46 878 82 401
Balance of Income over expenditure for the year7 46 986 27 849
1 In the 2010 income contributions from the Kuwait Patients Helping Fund Society (US$ 342 thousands) have been included in the funds received from Foundations and others instead of being made part of funds from Governments and their Agencies. Accordingly, the 2009 amount (US$ 160 thousands) for contributions from Foundations and others has been restated in line with this classification approach, which will be used in future financial reports.
2 As per WHO published financial report for 2010, total contributions were US$ 93.892 million which does not include the 2010 in kind contribution from Novartis of US$ 2.005 million.
3 Prior year adjustment arises due to the alignment of the Stop TB Partnership financial management report to WHO accounts
4 In line with the new classification of costs in the 2010 report, US$ 200 thousands categorised under Advocacy and Communications in 2009 has been restated under Partnership Building.
5 This report does not include US$ 87.254 million for income and expenditure related to GDF Direct Procurement in 2010 (2009, US$ 47.979 million), as these transactions do not pass through the Stop TB Partnership Trust Fund. These details have been explicitly shown in the GDF Financial Statement as there is an associated cost related to operating the Direct Procurement process.
6 Expenditure for General Management and Administration rose as a result of greater overall expenditures, which resulted in proportionately higher WHO Programme Support Costs, in 2010.
7 This includes transfer to reserves of US$ 900 thousands for the year 2010, as mandated by the Coordinating Board. Reserves have been set aside and will be maintained at the levels set by the Board from time to time; the current reserve levels will be reflected in WHO accounts in 2011. The surplus of income over expenditure comprises US$ 8.520 million specified funding for TB REACH, US$ 1.684 million for the Partnership Secretariat (of which US$ 400 thousands transferred to reserves) and US$ 17.645 million (of which 500 thousands transferred to reserves) for the Global Drug Facility, of which more than US$ 14 million is due to funds received in late December 2010.
52 Annex I Stop TB Partnership Financial Management Report Annex II Stop TB Partnership Global TB Drug Facility Summary Financial Management Report Summary Statement of Income, Contributions Available for Direct Procurement and Expenditures for the year ending 31 December 2010 (all figures in US$ ‘000)
2009 2010 Income Government & their Agencies - specified 33 796 34 728 Multilateral institutions 23 208 21 753 In kind contribution for drugs from Novartis 1 690 — Foundations and others 160 426 Total voluntary contributions 58 854 56 907
Other income and adjustments Income for direct procurement 47 979 87 254 Other income 30 — Internal transfers to GDF from contribution received 636 — by TBP Secretariat Prior year adjustment -1 650 13 797 Sub-total 46 995 101 051 Total income 105 849 157 958
Expenditure Grant procurement of Anti TB drugs1 22 134 42 748 Special direct financing of procurement by countries2 — 1 850 Direct Procurements 47 979 87 254 Quality assurance and prequalification3 469 784 Technical assistance, Monitoring and Salaries4 4 123 4 155 Advocacy and Communications & management5 448 545 Indirect costs 764 1 010 Total expenditure 75 917 138 346
Funds transferred to GLI6 1 126 1 967 Total of expenditures and fund transfers 77 043 140 313
Balance of income over expenditure for the year* 28 806 17 645
* This includes transfer to reserves of US$ 500 thousands for the year 2010, as mandated by the Coordinating Board; the current reserve levels will be reflected in WHO accounts in 2011. Balance of income over expenditure of US$ 17 million is due primarily to US$ 14 million in funds received in December 2010.
N.B. Items (1), (2), (3), (4), (5) and (6) together amount to US$ 52.049 million for 2010 and US$ 28 300 million for 2009 showing the total direct expenditures of the Global Drug Facility indicated in Annex I.
Contributions for Direct Procurements (DP) are funds made available for procurement of anti-TB drugs to countries from various sources, for example the Global Fund. These funds do not pass through the Stop TB Partnership Trust fund, hence they do not feature in the Summary Statement of Income and Expenditure of the Stop TB Partnership Financial Management Report, but are reported here as there is an associated cost with managing the DP process in terms of staff time.
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