4. KESHAVJEE_GLC Slides for by elusivelyeasy


									              Role of the
    Green Light Committee Initiative
    in MDR-TB Treatment Scale-up



                       APRIL 3, 2009

1                                         Green Light Committee Initiative
                PURPOSE OF THE GLC

    Created in 2000 by the WHO and the Stop TB
    Partnership to ensure:
       Access to quality assured second line drugs at
       affordable prices
       Monitoring and evaluation of second-line drug use in
       approved projects
       Promotion of technical assistance for MDR-TB

2                                             Green Light Committee Initiative
                Green Light Committee – 2000 to 2009
    •   WHO, CDC, IUATLD, Latvian National TB Programme,
        Partners In Health/Harvard Medical School, Médecins Sans Frontières,
        KNCV, Hospital F.J. Muniz – Argentina, World Care Council.
    •   Former members include: Medical Research Council (South Africa), Estonian
        National TB Programme and the Peru National TB Programme.

    •   A legal advisory body of the WHO
    •   A sub-group of the Working Group on MDR-TB in the Stop TB Partnership

    1. Provide policy advice on drug-resistant TB to the WHO.
    2. Review project applications for countries entering the GLC mechanism.
    3. Promote technical assistance to countries/programs through WHO and
       its partners.
    4. Provide access to reduced-priced 2nd line anti-TB drugs through GDF.
    5. Provide access to independent monitoring and evaluation through WHO and
       its partners.
3                                                            Green Light Committee Initiative
                                GLC Initiative: 8 years (2000 to 2008)

                        60000                                                                                     160

                                                                                      ~ 50'000                    140
                        50000           GLC approved (cumulative)                     patients
                                                                                    approved for                  120
                                        Cumulative number of applications
    Patients approved

                        30000                                                                                     80




                           0                                                                                      0
                                2000   2001      2002       2003      2004   2005     2006   2007        2008

4                                                                                                  Green Light Committee Initiative
                    GLC approved projects as of December 2008
                                    134 applications in 61 countries                  1.    Armenia
                                                                                      2.    Azerbaijan
                               ~ 50'000 patients approved for enrolment               3.    Belarus
                                                                                      4.    Bulgaria
                                                                                      5.    Estonia
                                                                                      6.    Georgia
                                                                                      7.    Kazakhstan
                                                                                      8.    Kyrgyzstan
                                                                                      9.    Latvia
                                                                                      10.   Lithuania
                                                                                      11.   Moldova
                                                                                      12.   Romania
                                                                                      13.   Russia
                                                                                      14.   Serbia
                                                                                      15.   Tajikistan
                                                                                      16.   Ukraine
                                                                                      17.   Uzbekistan

                                                                              1.   Bangladesh
                                                                              2.   India
                                                                              3.   Indonesia
                                                         1.   Egypt           4.   Myanmar
    1.    Belize                                         2.   Jordan          5.   Nepal
    2.    Bolivia                                        3.   Lebanon         6.   Timor-Leste
    3.    Costa Rica                                     4.   Pakistan
    4.    Dominican Republic                             5.   Syria                    1.   Cambodia
                                 1.    Burkina Faso
    5.    Ecuador                                        6.   Tunisia                  2.   China
                                 2.    Cameroon
    6.    El Salvador            3.    DR Congo                                        3.   Micronesia
    7.    Guatemala              4.    Ethiopia                                        4.   Mongolia
    8.    Haiti                  5.    Guinea                                          5.   Philippines
    9.    Honduras               6.    Kenya                                           6.   Samoa
    10.   Mexico                 7.    Lesotho                                         7.   Vietnam
    11.   Nicaragua              8.    Mozambique
    12.   Paraguay               9.    Rwanda
    13.   Peru                   10.   Uganda
    14.   Uruguay                11.   Tanzania
5                                                                         Green Light Committee Initiative
               Successful collaboration with donors
                                       "To help contain resistance to second-line
                                       anti-TB drugs and consistent with the
                                       policies of other international funding
                                       sources, all procurement of medications to
                                       treat MDR-TB must be conducted through
                                       the Green Light Committee (GLC)"
                                       Third Board Meeting, 10-11 October, 2002

    Second-line drugs for low and lower-middle
    income countries; thousands of patients to be
    enrolled in 2007-2011; creation of a Global
    Buffer Stock of SLDs and a Revolving Fund

                                        Funds for Technical
                                          Assistance and

6                                                                Green Light Committee Initiative
                                     Technical Documents

7   Source: http://whqlibdoc.who.int/publications/2008/9789241547581_eng.pdf   Green Light Committee Initiative
                   Contribution to MDGs

    The GLC mechanism contributes to the following
    Millennium Development Goals:
       Meeting the global tuberculosis control targets and prevent
       development of almost incurable forms of TB (XDR-TB)
       (MDG 6, target 8)

       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 (MDG 8, target 17, WHA 60.19);

8                                                  Green Light Committee Initiative
                Green Light Committee Initiative: Components
                               Green Light
        Green Light            Committee                 WHO                    Global Drug
        Committee              Secretariat           Stop TB Dept                 Facility
                             (housed in the WHO)

    • Policy advice         • GLC administration   • Technical Assistance   • Drug Procurement
    • Application review

           High-level expertise on the management of MDR-TB programmes based on best
           available evidence and collective experience.

           Peer support and knowledge sharing in communication with other GLC-approved

           Technical assistance through a wide network of technical partners.

           Independent external monitoring and evaluation of approved programmes.

           Quality-assured second-line drugs to treat MDR-TB at concessionary prices.

9                                                                           Green Light Committee Initiative
                     General strategy for MDR-TB Scale-up

                                 Development of a
                              GLC-approved pilot project

                             Expansion of the pilot project
     can provide
     TA at every
     stage of this
                                   Integration into the
                              national TB control strategy

                          Nationwide scale-up/universal access

10                          Countries Need to Drive Process      Green Light Committee Initiative
            The GLC Initiative: Understanding the Process


                                        GLC               GDF:
     GLC Secretariat
                                  Expert committee     Procurement
                       2 months

         WHO:                                                GDF
       Technical                   Country/Project    Procurement Agent
     Support / M&E
11                                                   Green Light Committee Initiative
     Lessons Learnt from Current GLC Projects & WHO DRS Data

     1.   Need to treat all DR-TB patients as early as possible with
          quality assured drugs and under sound programmatic
          conditions in order to prevent transmission of DR-TB.

     2.   MDR-TB management through the GLC strengthens basic TB
          control, helps to improve the quality of DOTS, and contributes
          to health systems strengthening

     3.   Integrating MDR-TB treatment into national programs can be
          difficult in many settings due to the fact that it is demanding,
          complex and costly.

            •   Implementing pilot projects
            •   Integrating DR-TB treatment within national TB control
            •   Expanding treatment to provide universal access in rural
12              and urban areas                             Green Light Committee Initiative
             Areas of MDR-TB Management: Main Obstacles

         DIAGNOSIS                       DRUGS                 CARE DELIVERY

       Appropriate and               Uninterrupted            Delivery of care for
     timely diagnostics               access to                 two years with
                                    quality-assured               appropriate
                                   second-line drugs           management of
                                                               adverse events

      Programs need help to
     build laboratory capacity
     for diagnosis of patients     Programs need help in
          and monitoring of        the area of drug supply
     treatment. This includes       management (TB and
       the implementation of         ancillary drugs) and      Programs need help with
            available new                forecasting                  pilot program
        diagnostics (GLI and                                     implementation, DR-TB
              partners).           Global supplies of drugs    treatment integration into
                                      and procurement              national TB control
                                   mechanisms need to be      strategies, capacity building
                                        strengthened               (HR), and scale-up

13                               Monitoring & Evaluation             Green Light Committee Initiative
     Green Light Committee Initiative: Enhancing the mechanism for scale-up

                               Green Light
         Green Light           Committee                          WHO                  Global Drug
         Committee             Secretariat                    Stop TB Dept               Facility
                             (housed in the WHO)

     • Policy advice        • GLC administration            • Provides technical   • Drug Procurement
                            (includes Training and          assistance to
     • Application review
                            coordination of GLC             programs (pre- and
                            consultants)                    post-application)
                                                            through the MDR-TB
                                                            team and partners

                                        GLC MDR-TB Support Unit
                                        •   data collection from internal and
                                            external sources
                                        •   data analysis
                                        •   coordinate TA (long-term; on-site)
                                            to countries (GLC and non-GLC
                                            countries) working with TB Team
                                            and partners
                                        •   provide assistance on drug

14                                                                                 Green Light Committee Initiative
            The GLC mechanism and the future…

     The GLC mechanism is working with projects and
     countries to facilitate scale-up of DR-TB treatment.
     The success of the mechanism depends on:
       •   Push from countries themselves for integrated DR-TB
       •   Reliable supply of QA drugs at concessionary prices
       •   Newer models of technical assistance stressing
           long-term, on-site approaches that build local capacity
       •   Sufficient funding for countries to implement programs
       •   Sufficient staffing and financial resources at the level of the
           GLC mechanism to ensure its functions – WHO member
           countries have a direct stake in this

15                                                         Green Light Committee Initiative

16               Green Light Committee Initiative

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