TB-AP 2016-2020 development process and progress...The End TB Strategy: Vision, goal, targets 2035 VISION A world free of tuberculosis – zero deaths, disease and suffering due to

TB-AP 2016-2020 development

process and progress

17th Wolfheze Workshops The Hague, Netherlands, 27 May 2015

Dr Masoud Dara Programme Manager a.i.

Tuberculosis and multidrug-resistant tuberculosis Division of Communicable Diseases, Health Security and Environment

WHO Office for Europe

© Maxim Dondiuk

© Carl Cordonnier

© Maxim Dondiuk

© Carl Cordonnier

Achievements under the Consolidated Action Plan, 2011-2015

Treatment coverage for MDR-TB

Default rate among new lab-confirmed TB patients

MDR-TB case detection

SLD stock-outs in HPCs

FL DST coverage

Electronic case-based data management at least for MDR

Advocacy, partnership & addressing needs of special populations

Impressive improvement in coverage of treatment for MDR-TB, 2009–2013

28 456

33 957 34 184

36 877

39 924

17 169

27 324

34 210

39 865

45 079

0

5 000

10 000

15 000

20 000

25 000

30 000

35 000

40 000

45 000

50 000

2009 2010 2011 2012 2013

MDR cases notified MDR cases enrolled in treatment

Cas

es

TB-AP Progress of Development

(2011 – 2015) 2014 Endorsed by

WHA (2016 – 2020)

The End TB Strategy: Vision, goal, targets 2035

VISION A world free of tuberculosis

– zero deaths, disease and suffering due to tuberculosis

GOAL End the global tuberculosis epidemic

INDICATORS MILESTONES TARGETS

2020 2025 SDG 2030* END TB 2035

Reduction in number of TB deaths

compared with 2015 (%) 35% 75% 90% 95%

Reduction in TB incidence rate

compared with 2015 (%)

20%

(<85/100 000)

50%

(<55/100 000)

80%

(<20/100 000)

90%

(<10/100 000)

TB-affected families facing

catastrophic costs due to TB (%) Zero Zero Zero Zero

PRINCIPLES

1. Government stewardship and accountability, with monitoring and evaluation

2. Strong coalition with civil society organizations and communities

3. Protection and promotion of human rights, ethics and equity

4. Adaptation of the strategy and targets at country level, with global collaboration

TB-AP Process & Progress of Development

Endorsement of TBAP to Regional Committee along with MAP final report September 2015

Final Review of TBAP NTP Manager’s meeting /Wolfheze May 2015

Draft TBAP reviewed by the Standing Committee of the Regional Committee (SCRC) 16 May 2015

Draft TBAP public consultation March-April 2015

2nd meeting of the TB-AP Advisory Committee 4 March 2015

TAG and 1st Regional Consultation, WHO Regional Office for Europe, Copenhagen

25-27 November 2014

1st meeting of the TB-AP Advisory Committee 3 October 2014

Drafting outline of TBAP August-September 2014

Review the lessons learnt from implementation of Consolidated Action Plan 2011-2015

TB-AP 2016-2020 Advisory Committee

TB-AP Advisory Committee: Key recommendations

• Focus of the plan should be all TB, not just MDR–TB, with an emphasis (not exclusive) on high-burden countries

• No affected families with catastrophic costs due to TB (measurable element of this)

• Targets

– 35% reduction in TB deaths

– 25% reduction TB incidence rate (25/100 000) (based on the current model of estimates)

– Successfully treat at least 75% of MDR-TB cases

• 5 Strategic directions

Regional Consultation Key recommendations

1. Pillar 1: Integrated, patient-centred care and prevention

2. Pillar 2: Bold policies and supportive systems

3. Pillar 3: Intensified research and innovation

– Include “improve access to health care”

– Effective patient communication – patients must have access to quality, understandable information.

– Add aspects regarding affordability and cost-effectiveness in accordance with WHO recommendations and guidance.

– When discussing TB diagnostics, the Action Plan should be broader than just mentioning GeneXpert and avoid brand names of the tools.

– When clearly specifying hard-to-reach populations, include stateless people.

Outline of TBAP, 2016-2020

Inspired by the End TB Strategy and the Framework Towards TB Elimination in Low-incidence Countries

Based on the lessons learnt in the implementation of Consolidated Action Plan

Aligned with the Health 2020 European strategy and the ECDC’s Framework Action Plan to Fight TB in the EU

Vision: An end to the TB epidemic with zero affected families facing catastrophic costs due to TB

Goal: To stop the spread of drug-susceptible and drug-resistant TB by achieving universal access to prevention, diagnosis and treatment in all Member States of the WHO European Region.

Targets: 35% reduction in TB deaths 25% reduction in TB incidence rate 75% treatment success rate among the MDR–TB patient cohort

Strategic directions

1. Work towards strengthening health systems response to DR-TB prevention,

control and care and TB elimination;

2. Facilitate inter- and intra-sectoral collaboration to address the social

determinants and their underlying risk factors of TB;

3. Work in national and international multi-stakeholder partnerships, including civil

societies and communities;

4. Foster collaboration for the development and use of new diagnostic tools,

medicines, vaccines and other treatment and preventive approaches;

5. Promote the rational use of existing resources, identify gaps and mobilize

additional resources to ensure sustainability.

TBAP Areas of intervention

INTEGRATED, PATIENT CENTRED CARE AND

PREVENTION 1. Screening of contacts and

high-risk groups 2. Early diagnosis of

tuberculosis and universal DST and use of rapid tests

3. Equitable access to quality treatment and continuum of care for all TB patients,

4. Collaborative TB/HIV activities; and management of comorbidities

5. LTBI and preventive treatment; and vaccination against TB

INTENSIFIED RESEARCH AND INNOVATION

1. Discovery, development

and rapid uptake of new tools, interventions and strategies

1. Research to optimize

implementation and impact, and promote innovations

BOLD POLICIES AND SUPPORTIVE SYSTEMS

1. Political commitment including universal health coverage policy with adequate resources

2. Strengthened health system including financing mechanisms

3. Regulatory frameworks for case-based surveillance, strengthening vital registration, quality and rational use of medicines and pharmacovigilance

4. Infection control programme in all relevant health facilities and congregate settings

5. Community systems strengthening and coordination with civil society

6. Social protection, poverty alleviation and actions on other determinants of TB such as migration and prisons

Projected acceleration of TB incidence decline to target levels: Global level

Optimize use of current & new tools emerging from pipeline,

pursue UHC and social protection

Introduce new tools: a vaccine, a new easier prophylaxis & treatment

regimen, a PoC test

Average -10%/year by 2025

-5%/year

Current global trend: -1.5%/year

Average -17%/year

Projected trends in TB incidence, WHO European Region, 2015-2035

0

5

10

15

20

25

30

35

40

2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035

Incid

en

ce r

ate

per

100,0

00

TB-AP#2 2021-2025

50% decrease by 2025

TB-AP#3 2026-2030

80% decrease by2030

TB-AP#1 2016-2020

25% decrease by 2020 TB-AP#4: 2030-2035

90% decrease by 2035

Optimize use of current &

pursue UHC and social

protection: -5.5%/year

Acceleration of decline: new tools

emerging from pipeline: -10%/year

Effective preventive treatment , new treatment

regimen and vaccine, : -17% /year

Source: Ending TB in WHO European Region = dream or authenticity; unpublished work in progress; TB cluster of WHO/Europe

Acknowledgements

• WHO Regional Office and Country Offices

colleagues particularly Dr Colleen Acosta, Dr

Andrei Dadu and Dr Martin van den Boom

• Member States and partners

Thank you very much

for your attention