Global Drug Resistant TB Initiative (GDI)

Charles L. Daley, M.D.

National Jewish Health

Chair, GDI Core Group

Diagnosis Treatment

Disclosures

• Chair, Data Monitoring Committee for delamanid trials in adults (Otsuka)

• Member, Data Monitoring Committee for delamanid trials in children (Otsuka)

Outline

• Transition from GLC to GDI

• What is the GDI?

• Strategic priorities of the GDI

• Progress to date

• Future plans

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Global

DRS

project

launched

Green Light

Committee

established

The first WHO

MDR-TB

guidelines

100,000 (104,537)

patients approved

by GLC for treatment.

New framework

for the PMDT

WHO Working

Group on DOTS-

Plus for MDR-TB

The 1st DOTS-

Plus project

launched

Ministerial

meeting in

Beijing: "Call for

Action" 62nd WHA

resolution on

MDR-TB

Green Light Committee to New Framework for PMDT

Green Light Committee(GLC) Initiative

Objectives:

• Contribute to the progress towards meeting global tuberculosis control targets and prevent development of almost incurable forms of TB (XDR-TB)

• Increase access to quality-assured, affordable second-line drugs for the treatment of drug-resistant TB (DR-TB) among well-performing TB control programs in developing countries

Rationale for the New Global Framework

• Very few MDR-TB patients on treatment

Only 11% of people with MDR receiving any treatment

Less than 3% of people receiving care of known quality

• Revision of the global framework was urgently required

‘Shift from a controlling to a supporting mode’ Three Task Forces:

I. Provision of technical assistance

II. Availability of quality assured second-line TB drugs (SLDs)

III. Monitoring and evaluation, and the governance structure for MDR-TB management scale-up

Decentralization Establishment of Regional GLCs

6 rGLCs

1 gGLC

Global GLC Committee (gGLC)

Global level strategic gGLC with dual role of advising Stop TB Partners and WHO.

1. a sub-group of the MDR-TB working group of the Stop TB Partnership and

2. an advisory committee to WHO and Partners

• Members appointed in individual capacity

• All relevant technical areas, constituencies and regions are represented

Regional GLC Committee (rGLC)

Regional advisory committee with dual role of advising Stop TB Partners and WHO Regional Offices to guide countries on scale-up

1. Phased decentralization to regions

2. All relevant technical areas and constituencies represented

3. Composition should reflect the different needs of the respective region

Transition from GLC to GDI

• Joint meeting of the Global GLC and MDR-TB Core Group

– 18-19 April 2013

• MDR-TB Stakeholders meeting

– 27-28 October 2013

• First Core Group meeting in

– 1-2 May 2014

• Second Core Group meeting

– 27 October 2013

GDI - Global Drug-resistant TB Initiative

GDI mission

• To serve as a multi-institutional, multi-disciplinary

platform organizing and coordinating the efforts of

stakeholders to assist countries to build capacity

for PMDT in the public and private sectors

• Ultimate aim: Universal access to care and

appropriate treatment for all DR−TB patients

Selection of GDI Core Group

• Call for applications for membership in Core Group (CG) in December 2013

• 87 applications were received

• Selection Committee

– Aamir Khan (Chair of ex-MDR TB WG)

– Lucy Chesire (Civil Society)

– Lee Reichman (regional GLC)

– Karin Weyer ( WHO)

• Aimed for a broad, constituency-based CG balanced by region, gender, skills base

GDI Core Group Members (1)

Member Constituency Represented Organization

Amy Bloom Donor/funding agency USAID

Chen-Yuan Chiang Technical agencies/implementation partners assisting NTPs or high burden DR-TB countries

The Union

Daniela Cirillo Technical agencies/implementation partners assisting NTPs or high burden DR-TB countries

St. Rafaele Hospital, Italy

Charles Daley (chair)

Academic institutions, institutions of high scientific and technical standing having attained international recognition in the area of DR-TB management

National Jewish Health, USA

Dalene von Delft Civil society, patients and affected communities

TB Proof

GDI Core Group Members (2)

Member Constituency Represented Organization

Agnes Gebhard (vice-chair)

Non-governmental sector partners KNCV

Saira Khowaja Private for profit sector Interactive Research and Development

Kuldeep Sachdeva National TB programmes of high DR-TB burden countries

NTP, India

KJ Seung Technical agencies /implementation partners assisting NTPs or high burden DR-TB countries

Partners in Health

Gini Williams National/international/scientific/professional medical and nursing associations

International Council of Nurses

Carrie Tudor Infection Prevention and Control Infection Control sub-Group

GDI Core Group Members (3)

Regional Green Light Committee (rGLC) Chairs

Hind Satti rGLC - AFR

Raimond Armengol rGLC - AMR

Essam Emoghazy rGLC - EMR

Andrey Olegorich Maryandyshev rGLC - EUR

Rohit Sarin rGLC - SEAR

Lee B. Reichman rGLC – WPR

Observers

Tom Shinnick Global Laboratory Initiative

Joel Keravac Global Drug Facility

GDI - Global Drug-resistant TB Initiative

GDI - Global Drug-resistant TB Initiative

Facilitate integration and coordination of efforts to align diagnostic services for patients with access to high-quality care

Develop targeted advocacy strategies and resource mobilization for DR-TB management scale-up

Build global consensus on the management of DR-TB for patient-centred care delivery ("care for cure")

Promote strategies to facilitate patient access to high-quality DR-TB care through a long-term, in-country capacity building approach

Facilitate effective knowledge sharing among partners and harmonise coordination with existing technical assistance mechanisms

Support prioritization of research to generate evidence for PMDT

Strategic Priorities

Three TASK Forces

TASK Force Lead Collaborators Activities

Support prioritization of research to generate evidence for PMDT

Agnes Gebhard Chen Yuan Chiang

Carole Mitnick, Susan van den Hof, RESIST TB, Arnaud Trebucq

1. DR-TB research agenda 2. Overview of ongoing research activities 3. Develop a generic protocol for shorter treatment regimens

Build global consensus on the management of DR-TB for patient-centred care delivery ("care for cure")

Gini Williams

WPR rGLC Philippine NTP Philippine Nurses Association

Held training course in Quezon City, PI 17-21 November, 2014 with nurses from 10 countries

Develop targeted advocacy strategies and resource mobilization for DR-TB management scale-up

Dalene von Delft

Visual Epidemiology, Stop TB Partnership, GDI, TB Proof, and WHO

The Human Spirit Project

GDI - Global Drug-resistant TB Initiative

Facilitate integration and coordination of efforts to align diagnostic services for patients with access to high-quality care

• Develop tool to standardize the evaluation of the diagnostic and treatment GAP at country level

• Pilot the tool in 5 high burden MDR-TB countries • Use tool to evaluate all high burden countries • Develop country specific interventions to close the gap

• Goal: Get all detected MDR-TB cases on QA regimens

Communication

GDI Website GDI Newsletter

Other Activities

• Organize and provide minutes for monthly teleconferences

• Maintain GDI Listserve, now with > 300 members

• Oversaw administrative and contractual distribution of funding for 3 GDI Task Forces

• Organized a webinar on QuanTB in coordination with GDF

• Partcipated in external evaluation of GLC agreement between GF and WHO

• Drafted proposed budget for FY 2014 USAID funding for GDI

• Coordinated preparation for GDI/GLI Joint meeting

• Co-ordinated with Sentinel Project for DR-TB training on pediatric TB and DR-TB in China

• Oversaw management of DR-TB training modules

Thank you!

Acknowledgements:

Stop TB Partnership

Global TB Program, WHO

GDI Secretariat

Fraser Wares

Medea Gegia

Karen Weyer

Vineet Bhatia (until 2015)