Anti TB drug surveillance-Aziz

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WHO/IUATLD Global Project on Anti-TB Drug Resistance Surveillance:

WHO/IUATLD Global Project on Anti-TB Drug Resistance Surveillance Damascus September 2002

Objectives of Anti-TB Drug Resistance Surveillance:

Objectives of Anti-TB Drug Resistance Surveillance Estimate the magnitude of the Anti-TB drug resistance level and pattern Monitor drug resistance trends Evaluate the effectiveness of TB control Programmes Planning of interventions and preventive activities Evaluate interventions and preventive activities To inform TB treatment Policy at country level Strengthen Laboratory Capacity at the country level through yearly proficiency testing and training courses in DST Advocacy to increase Political commitment Identify research needs

WHO/IUATLD Global Project:

WHO/IUATLD Global Project Guidelines: Basic Principles Accurate representation of the sample studied and careful calculation of its size. Data collection and analysis which differentiates between new and previously treated cases. Internationally accepted methodology and quality control of drug testing.

History The WHO/ IUATLD Global Project on Antituberculosis Drug Resistance Surveillance 1994-2002 :

History The WHO/ IUATLD Global Project on Antituberculosis Drug Resistance Surveillance 1994-2002 1997 The 1st Global report covered 35 countries/ geographic settings 2000 The 2nd Global report covered 58 countries/geographic settings 2003 The 3rd Global report is projecting data from ± 60 countries/ geographic settings

Current Activities:

Current Activities Anti-TB Drug Resistance Surveys Laboratory training Moscow and Lyon Secretariat of Laboratory Subgroup Coordination of International Quality Assurance (QA) activities including shipment of strains for PT and QA Guidelines Update Database development

Global Project Coverage 1994-2003:

Global Project Coverage 1994-2003

Status of Regional Coverage :

Status of Regional Coverage

DRS in EMR 1994 - 2003:

DRS in EMR 1994 - 2003

Global Project Summary For Third Report 2003:

Global Project Summary For Third Report 2003 June 2002 Done Ongoing Planning High Burden Countries Expected inclusions Global Report 2003 60 Done Ongoing Planning 36 23 18 4 8 2

DST Training:

DST Training 2 training sessions for DST in 2002: Moscow “December”: 5 Russian speaking Countries : Russia (3 Oblasts), Kyrgyzstan, Moldova, Georgia and Uzbekistan Lyon, France “January 2003”: 7 French speaking African Countries: Burkina Fasso, Burundi, DR Congo, Mali, Senegal, Togo and Rwanda

Laboratory Subgroup:

Laboratory Subgroup

Draft Plan Of Action of the LSG:

Draft Plan Of Action of the LSG Development of a laboratory assessment tool Assessment of 10 HBC Assisting in the implementation of improvement plans in 5 countries Assisting in the development of country-specific EQA for smear microscopy

PowerPoint Presentation:

SRLN Coordinating Laboratory, Antwerp, Belgium 20 SRL National Reference Laboratories Panel of 30 Strains yearly proficiency testing Panel of 20 Strains yearly proficiency testing QA of Survey Results Quality Assurance Programme for Anti-TB Drug Susceptibility Testing

WHO/IUATLD Supranational Reference Laboratories (SRL) Network:

WHO/IUATLD Supranational Reference Laboratories (SRL) Network AFRO Unit for TB Operational Research and Policy (NTRP), Pretoria, SOUTH AFRICA Institut Pasteur d'Algérie, Alger, ALGERIA AMRO Instituto de Salud Public de Chile, CHILE CDC, Atlanta, USA Massachusetts State Laboratory (MSL) Boston, USA EURO Institut de Médecine Tropicale, Antwerp, BELGIUM ( SRL Coordinating Laboratory) Forschungszentrium (FZB) Borstel, GERMANY Kuratorium Tuberkulose in der Welt, Gauting, GERMANY National Institute of Public Health, Prague, CZECH REPUBLIC Swedish Institute for Infectious Disease Control, (SIDC) Stockholm, SWEDEN Instituto Nacional de Saúde, Porto, PORTUGAL “Vall d'Hebron", Barcelona, SPAIN Istituto Superiore de Sanita, Rome, ITALY NIHEP, Bilthoven, NETHERLANDS Institut Pasteur, Paris, FRANCE Dulwich Public Health Laboratory (DPHL), London, UK SEARO TB Research Centre (TRC), Chennai, INDIA WPRO Research Institute of Tuberculosis (RIT), Tokyo, JAPAN Queensland Diagnostic and Reference Centre for Mycobacterial Diseases, Brisbane, AUSTRALIA Korean Institute of Tuberculosis, Seoul, REPUBLIC OF KOREA

SRL Candidate:

SRL Candidate EMR : NRL in Egypt AMR: NRL Argentina NRL Mexico WPR: Reference Laboratory Hong Kong

Guidelines and Software:

Guidelines and Software Guidelines currently being revised. Remaining question: What to do with MDR patients identified during the survey? With special consideration to countries where 2nd line drugs are not available. SDRTB4 is currently being field tested for release end 2002.

Next Steps:

Next Steps Continued expansion of the Global Project and monitoring of trends in countries with more than one data point. Development and release of the 3rd Global Report in March 2003 Strengthen collaboration between WHO HQ, Regional, Country Offices, NTP and other Partners in planning, monitoring and implementing anti-TB drug resistance surveillance

PowerPoint Presentation:

Ensure that DRS is a part of the country proposal for the Global Fund Ensure that reliable data on Drug Resistance are available or will be available before or at time of implementing interventions i.e DOTS Plus and/or GDF In collaboration with the DEWG, STB, SRL Network, TDR and other partners, broaden the scope of activities of the SRL to cover all TB laboratory technical and managerial aspects i.e. sputum smear microscopy, training, biosafety as a part of the Laboratory Subgroup Secretariat.

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