Modern TB Diagnostic Services: Optimizing the Old with the New 6 th Global Laboratory Initiative (GLI) Partners Meeting incorporating Global consultation of the TB SRL Network Global Forum of Xpert MTB/RIF Implementers Organized by the World Health Organization Global TB Programme
6 th Global Laboratory Initiative (GLI) Partners Meeting Modern TB Diagnostic Services: Optimizing the Old with the New 20 years of the Global DRS Project: its results and implications in TB care and control Mario RAVIGLIONE, MD Director, Global TB Programme World Health Organization Headquarters Geneva, Executive Board Room 30 April 2 May 2014
The Global Burden of TB -2012 Estimated number of cases Estimated number of deaths All forms of TB HIV-associated TB 8.6 (8.3-9.0) million 0.5 m in children 2.9 m in women 1.1 (1.0-1.2) million (13%) 1.3 (1.0-1.6) million* 74.000 in children 410.000 in women 320,000 (300k-340k) Multidrug-resistant TB 450.000 (300k-600k) 170,000 (102k-242k) Source: WHO Global Tuberculosis Report 2013 * Including deaths attributed to HIV/TB
Commemorating 20 years of the WHO TB Supranational Reference Laboratory Network Mainz, 13 June 1994: a dozen laboratories, under the leadership of Albert Laszlo, gave birth to the SRL network of WHO/Union During the period 1994-1997, some 22 SRLs were established under the direction of: Laszlo, Abe, Crawford, Boulahbal, Dawson, de Kantor, Drobniewski, Feldmann, Hoffner, Jain, Källenius, SJ Kim, Martin-Casabona, Pereira, Portaëls, Rüsch-Gerdes, Sticht-Groh & Bretzel, Urbanczick, van Klingeren, Vincent, Weyer.
Commemorating 20 years of the WHO TB Supranational Reference Laboratory Network In 2014, 33 specialized TB Laboratories cover all WHO regions
20 years since the start of the WHO Global Project on Drug Resistance Surveillance Baseline data now available from 70% of all countries globally (136/194) About 35 settings/countries provided results in 1994-1997 for the 1 st WHO DRS global report
Trend in the percentage change in estimated per capita rate of MDR-TB among new notified TB cases Time trends in MDR-TB No data One datapoint Two datapoints Non-significant trends Decreasing trends Increasing trends Decreasing trends Australia Israel Estonia Latvia Germany Portugal Hong Kong SAR, China United States of America Macao SAR, China Increasing trends Austria Mary El Republic, Russian Federation Botswana Tomsk Oblast, Russian Federation Finland Sweden Ivanovo Oblast, Russian Federation United Kingdom Karelia Republic, Russian Federation
20 years of WHO Global Project on Anti-TB Drug Resistance Surveillance Global Project launched SRLN launched 1st global DRS report 2nd global DRS report 3rd global DRS report 4th global DRS report M/XDR-TB report 2013 TB report 1994 1997 2000 2001 2003 2004 2008 2009 2010 2013 1st ed. DRS guidelines 2nd ed. DRS guidelines 1st ed. GL DRS/SLD 3rd ed. DRS guidelines 4th ed. DRS guidelines
The WHO Global DRS Project Instrumental in WHO policy development for PMDT 1996 2000 2006 2008 2011 2014 1998-99 Summary of WHO current position on MDR-TB To achieve TB control worldwide, WHO continues to consider implementation of sound TB control programmes following the DOTS strategy as a top priority for action. Recognizing that MDR-TB is a considerable threat to the effectiveness of DOTS in some areas of the world, WHO strongly supports pilot projects to assess the feasibility of DOTS-PLUS* interventions in a variety of settings, provided DOTS is in place or being simultaneously introduced. Based on the results of these pilot projects, WHO and its partners of the newly established Working Group on DOTS-PLUS for MDR-TB will formulate international policy recommendations on MDR-TB management. *A working definition of DOTS-PLUS is the following: DOTS-PLUS is a case management strategy designed to manage MDR-TB using 2 nd line drugs within the DOTS strategy in low-and middle-income countries.
WHO Policy Development for TB Diagnostics and Laboratory Strengthening The use of liquid medium for culture and DST, 2007 Definition of a new sputum smearpositive TB case, 2007 2013-2014 2012 Policy guidance on drugsusceptibility testing (DST) of second-line antituberculosis drugs 2008 2011 WHO policy statement: molecular line probe assays for rapid screening of patients at risk of multidrugresistant tuberculosis 2008 Same-day diagnosis of tuberculosis by microscopy 2011 2011 2011 2010 Fluorescent light-emitting diode (LED) microscopy for diagnosis of tuberculosis 2011
Xpert: updated WHO Recommendations, 2013 1. Xpert MTB/RIF should be used as the initial diagnostic test in individuals suspected of having MDR-TB or HIV-associated TB. (Strong recommendation) 2. Xpert MTB/RIF may be considered as a follow-on test to microscopy in settings where MDR-TB or HIV is of lesser concern, especially in further testing of smear-negative specimens. (Conditional recommendation acknowledging major resource implications) 3. Xpert MTB/RIF use also expanded to for use in childhood TB and extrapulmonary TB
The day when we will able to provide access to care for all people with X/MDR- TB in the bush of Swaziland and other remote inaccessible poor places will be the start of the elimination of MDR-TB from the world. Let us not forget: all began with the establishment of proper laboratories and DRS, followed by policy making based on evidence, quality-service provision, and universal access to diagnostics and drugs without causing catastrophic expenditure and more poverty. We still have a long way to go and we should all feel responsible!
Many thanks to all of you in the labs for your key work to end TB!