The 16th meeting of WHO’s Strategic and Technical Advisory Group for Tuberculosis (STAG-TB) opened on 13 June 2016 with the appointment of its new Chair, Prof. Ibrahim Abubakar, Director of the Institute for Global Health at the University College London, by WHO’s Director-General.
STAG-TB, which is made up of 23 members, advises WHO’s Global TB Programme on all its core functions in the TB response.
This year, STAG-TB was joined by over 200 partners from technical, civil society, financing, and academic institutions, as well as WHO staff from all 6 regional offices, 19 country offices and Headquarters.
A key theme that resonated throughout the sessions over three days was innovation. Discussions focused on the need to use innovative approaches in rolling out existing tools and investment in new innovations to end TB.
WHO’s Assistant Director-General for HIV/AIDS, TB, Malaria and Neglected Tropical Diseases, Ren Minghui, gave an overview of health in the UN Sustainable Development Goals (SDG) agenda, emphasizing that WHO’s four new strategies for HIV, TB, malaria, and neglected tropical diseases, are all aligned with the SDG themes of universal health coverage, equity and poverty elimination.
Mario Raviglione, WHO’s Global TB Programme Director, stressed at the opening, that a paradigm shift is urgently needed in the TB response to move from stopping TB to ending it altogether. He highlighted the potential of various innovations that could “leapfrog” efforts forward to end TB – including precision medicine (genomics), big data, digital technology (“Internet of Things”), social impact tools and research. He called for smarter investment in innovation to reap greater benefits, while simultaneously strengthening the basics of TB prevention and care.
Engaging political leaders in the fight to end TB was flagged as a priority for WHO over the coming year, culminating in a global ministerial meeting on ending TB in the context of the SDGs, to be held in Moscow in late 2017.
STAG-TB members drafted recommendations based on the discussions that took place during the meeting and WHO will issue a report which will be made available soon on the WHO website at www.who.int/tb/advisory_bodies/stag/.
Brief highlights on the 9 topic areas that received STAG-TB advice this year are outlined below:
Support to End TB Strategy adaptation and roll-out
An outline of global efforts and advocacy in supporting country adaptation and implementation of the End TB Strategy was presented. Operational pointers to help countries transition to the new Strategy were reviewed along with measurement indicators of country progress. The annual Global TB Report will begin reporting on these new End TB indicators this year.
WHO’s regional offices provided an overview of their regional End TB frameworks, highlighting how they are supporting countries in implementing the End TB Strategy. In the Western Pacific region, for example, WHO is supporting countries on financial sustainability planning as part of its regional framework. Both the European and Eastern Mediterranean regions are helping to address TB in the context of the current migration crisis. In the Americas, WHO is supporting the TB in Big Cities initiative. WHO’s South-East Asia Regional Office has developed “fast track” models to end TB in the region. WHO’s African Regional Office presented the region’s End TB Strategy framework, which will be reviewed at its upcoming regional committee.
The session ended with a presentation on a patient pathway assessment commissioned by The Bill & Melinda Gates Foundation to identify key barriers to diagnosis, treatment and cure of TB patients. Ethiopia's patient pathway profile was reviewed as a case study. STAG-TB members welcomed the assessment as a good way of helping countries target their TB response to the needs of patients in their settings.
TB impact measurement
The updated mandate of the WHO Global Task Force on TB Impact Measurement in the context of the SDG era was presented. In addition to surveillance and surveys, the measurement of costs faced by TB patients and their households was included within the strategic areas of work of the task force. The next steps for the task force include working with the 30 highest TB burden countries to strengthen TB surveillance as part of efforts to “know your epidemic”. The need for increased guidance to countries on the preparation of prevalence surveys, and use of “big data” in the context of TB surveillance was also discussed.
Integrated patient-centred care
This comprehensive session covered a range of topics, from new WHO recommendations on TB/MDR-TB diagnosis, treatment, and care, to the overall MDR-TB response.
WHO’s new recommendations to speed up detection and improve treatment for patients with MDR-TB through the use of a novel rapid diagnostic test and a shorter, lower-cost treatment regimen were overviewed and next steps for roll-out in collaboration with partners were outlined. Results from a multi-country population-based surveillance project to investigate resistance to pyrazinamide and fluoroquinolones among TB patients were also reviewed.
The global response to the MDR-TB crisis was presented highlighting future plans for intensifying the response in collaboration with partners.
WHO recommendations on 3 new diagnostics were overviewed as well as WHO’s work on developing guidance on the strategic and programmatic use of chest radiography for TB detection. WHO is also reviewing evidence on computer-aided detection of TB.
Harmonization of all guidelines on the diagnosis and treatment for TB and MDR-TB into a “how to” implementation manual was extensively discussed.
Programmatic management of LTBI
The second morning opened with a session on recent progress made by WHO in addressing latent TB infection (LTBI), including the establishment of the Global LTBI Taskforce and identification of
barriers for effective LTBI management. Next steps were discussed including the development of pragmatic implementation (how-to) tools, consolidated LTBI guidance, monitoring and evaluation frameworks, as well as technical assistance to countries for implementation.
Moving towards effective social protection
STAG-TB members applauded WHO’s leadership in promoting social protection for TB patients as part of larger UHC and social protection efforts. TB disproportionately affects the poor, TB and its care can have impoverishing effects on households.
Today only one third of people worldwide are covered by social safety nets.
The importance of national TB patient cost surveys was also highlighted, for advocacy and for informing policies aimed to minimize financial access barriers and socioeconomic consequences of TB. This will be critical to monitor progress towards the End TB Strategy target to eliminate catastrophic total costs due to TB.
Experiences from Kenya and Myanmar in linking TB to existing social protection schemes, including cash transfers for key vulnerable groups, and nutritional assessment and support, were presented as potential models for other countries.
Intensified research and innovation
WHO’s work on the development of Target Regimen Profiles for TB treatment, and ‘how to’ tools in defining country-specific TB research priorities were reviewed. STAG-TB commended the progress made in ‘path-finding’ countries in promoting TB research and urged increased action to scale up roll-out and uptake of new tools. There was a call to strengthen research capacity at the local level as well as increased investments in TB research.
Zoonotic TB
Actions taken by WHO to address the neglected area of zoonotic TB were presented in collaboration with The Union, the World Organisation for Animal Health (OIE), and the Food and Agricultural Organisation of the United Nations (FAO). Presenters emphasized the need for a One Health approach that links animal, human and environment health in order to eliminate the risk of TB infection in humans. A zoonotic TB road map is expected to be finalized in early 2017.
Timpiyan Leseni from the Masai community in Kenya shared her painful experience with zoonotic TB and her journey to cure. She called for increased awareness and action on this area.
Engagement of NGOs and other civil society organizations
The last session focused on the progress made in community engagement for TB by partnering with NGOs and other civil society organizations (CSOs). WHO’s work to promote the meaningful participation of civil society in the TB response through the ENGAGE-TB approach was commended by STAG-TB and the expansion of current pilot projects was supported.