Welcome to Stop TB Canada’s e-Newsletter. STB Canada e-News serves as a quarterly communication forum between Stop TB Canada members and a source of information for the wider international health community on Stop TB activities in Canada and on international TB projects managed or supported by Canadian organizations.
Stop TB Canada was formed in February 2001 to support Canada in fulfilling its commitment to the G-8 Okinawa 2000 targets to reduce the global burden of TB by 50 percent by 2010. For more information on Stop TB Canada see the last section of this e-News.
In this issue
·
Stop TB Global
Partnership launches Global Plan to Stop TB 2006-2015
·
WHO launches new Stop TB
strategy
·
Canadian Society for
International Health: Public Health Strengthening in
Guyana
·
Canadian Lung
Association: Strengthening the
National TB Control Program in Ecuador
·
CARE Canada:
International TB Projects
·
World Vision Canada:
International TB Projects
·
XVI International AIDS Conference
in Toronto
·
More on Stop TB
Canada
Stop TB Global Partnership launches Global Plan to Stop TB 2006-2015
January 27, 2006
The Global Plan to Stop TB 2006-2015 was released on
January 27, and is a comprehensive assessment of what is needed in terms of
activities, resources, both human and financial, new tools and expanded programs
to reach the main target of reducing TB prevalence and deaths by 50% compared
with 1990 levels by 2015.
The Millennium Development Goals incorporate TB under
Target #6, aiming to halt and begin to reverse the incidence of TB by 2015, and
serving as a tool by which each country can measure progress and each donor can
determine their fair share. The Global Plan represents a step toward the
elimination of TB as a global health problem by 2050, and the realization of the
vision of a world without TB.
The Global Plan is available at:
http://www.stoptb.org/globalplan/
WHO launches new Stop TB strategy
March 17, 2006
WHO’s new Stop TB strategy provides the framework for the second Global Plan to Stop TB (2006–2015), enabling existing achievements to be sustained and addressing the remaining constraints and challenges, and supporting efforts to strengthen health systems, alleviate poverty and advance human rights. The components and implementation approaches of the new strategy are summarized as follows:
1. Pursue high-quality DOTS expansion and enhancement
a. Political commitment with increased and sustained
financing
b. Case detection through quality-assured bacteriology
c.
Standardized treatment, with supervision and patient support
d. An effective
drug supply and management system
e. Monitoring and evaluation system, and
impact measurement
a. Implement collaborative TB/HIV activities
b.
Prevent and control MDR-TB
c. Address prisoners, refugees and other high-risk
groups and situations
a. Actively participate in efforts to improve
system-wide policy, human resources, financing, management, service delivery,
and information systems
b. Share innovations that strengthen systems,
including the Practical Approach to Lung Health (PAL)
c. Adapt innovations
from other fields
a. Public–Public and Public–Private mix (PPM)
approaches
b. International Standards for Tuberculosis Care (ISTC)
a. Advocacy, communication and social mobilization
b.
Community participation in TB care
c. Patients’ Charter for Tuberculosis
Care
a. Programme-based operational research
b. Research
to develop new diagnostics, drugs and vaccines
http://www.stoptb.org/news/archives/stbstrategy/
Canadian Society for International Health (CSIH):
Managed by the CSIH and funded by the Canadian International Development Agency, PHSG is a capacity building project focused on improving and maintaining the health of Guyana's population. The project has four components:
1. Expanding and Strengthening the Prevention Management
and Care of STIs/HIV/AIDS
2. Improving the National Tuberculosis Prevention and
Control Program
3. Strengthening the Health Information
System
4. Community Health Development and Care
· the development of National TB
Guidelines;
· assistance in the reactivation of a local NGO – the
Guyana Chest Society;
· implementation and expansion of DOTS in four regions of
Guyana;
· institution of an annual National TB Conference in
collaboration with the Guyana Chest Society;
· setting up of three TB laboratories including a central
lab with the capacity to do cultures; and
· establishment of a lab network with links to reference
labs at CAREC and the National Microbiology Laboratory (NML) in Winnipeg, where
respectively first-line and second-line drug sensitivity testing are done.
Research has also been a focus of the project including two recent studies looking at TB treatment adherence, one on the influence of nutrition and the second on other factors that contribute to adherence. Two other studies are in the works: one to establish the prevalence and resistance patterns of resistant strains of TB in Guyana, and the other on patient and demographic predictors of smear-positive tuberculosis. PHSG also works on home-based and palliative care and with all educational institutions and professional organizations in Guyana to ensure that training and new standards of care are sustained.
Canadian Society for International Health
http://www.csih.org/
The Public Health Strengthening in Guyana (PHSG) Project
http://www.csih.org/what/guyana/indexguyana.html
TB control component of PHSG
http://www.csih.org/what/guyana/presentations/TB_Nov2004.ppt
Canadian Lung Association:
Strengthening the National TB Control Program in Ecuador
Since 1999 the Canadian Lung Association (CLA) has been conducting an international development program to strengthen TB control in Ecuador. The program was funded by an initial CIDA bilateral agreement signed in October 1999 and was extended through a CIDA grant in 2004 which was completed in March 2006.
At the beginning, Ecuador had the worst TB control program in the Americas. CLA started the implementation of the DOTS program for TB control in three pilot provinces with about 50% of the country’s TB cases. Within 18 months a TB cure rate of 80% was established. The project was expanded to three more provinces which were completed in 2005. Expansion into two more provinces has just begun. Within the next year, over 80% of the population of Ecuador will have access to free TB diagnosis and treatment. The treatment success rate is now 86.4%.
From the beginning of the project, all activities were designed to leave Ecuador with a sustainable national TB control program. Local Ecuadorians were hired and trained for all of the leadership and management positions. Through the DOTS implementation program over 4000 health care professionals have been trained to diagnose and treat TB. The expansion strategy was designed such that the local health care system was able to absorb and continue the operational costs of providing TB control services in each area that DOTS was implemented.
CLA assisted Ecuador in its application to the global fund for AIDS, TB and Malaria. The application was successful in getting $16 million for Ecuador to continue DOTS expansion throughout the entire country.
Part of the plan for sustainability was the creation of a local anti-tuberculosis association in Ecuador which would continue the work when CLA left and expand the community aspects of the program and increase TB case detection. The new Fundación Ecuatoriana de Salud Respiratoria is now operational. CLA transferred all of its 25 Ecuadorian staff to this Foundation and assisted the new Foundation to become a subcontractor for DOTS implementation using the global fund money. The Lung Associations of Saskatchewan and BC have each provided grants of $5000 to the new Foundation for the necessary start-up expenses to register the Foundation and set up a webpage, e-mail, etc. and to begin applying for other grants.
CLA will continue to work together with its sister association in Ecuador in the global effort to control TB. For more information go to:
http://www.sk.lung.ca/content.cfm?edit_realword=tb-ecuador-main
CARE Canada:
International TB Projects
CARE Canada’s international TB projects
include a CIDA supported one in India as well as projects in Indonesia and
Zambia that are supported through other donors. In addition, our home based care
HIV programmes in Zambia, Zimbabwe, Cameroon, Ethiopia and Kenya assist
chronically ill patients and their families to suspect TB and adhere to TB
treatment. HIV prevention programmes in many more countries include TB in HIV
messaging.
The Community Based DOTS Project (CB-DOTS),
implemented with CARE India and the Revised National Tuberculosis Control
Programme (RNTCP) in West Bengal State, seeks to break the cycle of TB
transmission through developing sustainable systems for strengthening community
participation in TB control. The project’s strategy is to raise community
awareness, promote health seeking and enhance treatment adherence. It works
closely with local NGOs, Panchayats (local government), family members, cured
patients and volunteers. Treatment observation and default retrieval are key
aspects with all strategies are driven by the need to increase case detection
and treatment success.
While the
project’s first four years were implemented in five entire Districts, the focus
since August 2005 has been on specific Treatment Units (TU) where TB control has
been difficult. We were, moreover, challenged by CIDA to demonstrate the
incremental difference that community participation has on detection, as this
investment is in addition to ones in the RNTCP and WHO. We did this by selecting
control TUs and monitoring detection over a six month trial period. The results
are that:
· in intervention sites,
case detection rate (CDR)
expressed as a percent of estimated incidence for new sputum positive (NSPs),
increased by 36%, compared to 12% in the controls, a difference of
24%;
· case detection for all cases increased by 17%; it
increased by 1% in the controls, a difference of 16%;
· NSP cost per additional success remained below CAD $200
for both the entire project and the trial period: the former is $125 and the
latter $138.
Our TB project in Indonesia uses a similar model while in Zambia the focus is more upon HIV co-infection and the need for detecting TB patients through HIV services and linking TB patients with VCT and HIV services.
For more information on CARE Canada projects:
http://www.care.ca/work/projects/projects_e.asp
World Vision Canada:
International TB Projects
FIGHT TB, Indonesia
The Food Integrated to Hinder Tuberculosis (FIGHT) project commenced in March 2000 and was set to end in October 2002. However, as significant funds remained, the project entered into no-cost extensions until September 2006, with a final wrap-up by December 2006. The intended impact of the project and is to reduce TB as a significant public health threat by 2010 among the people of Nusa Tenggara Timor province with a population base of more than 1 million.
The FIGHT project aims to improve the delivery of DOTS, through increased participation and commitment of District Government Units and DOTS implementers and through enhanced community participation. The key interventions are:
1. Improved implementation of the NTP TB program
protocols
2. Capacity building and training
3. Community mobilization
4. Monitoring and evaluation
5. Networking and advocacy
6. Mobilization of TB-related resources
7. Lobbying of District Government Units
8. Improving the nutritional status of
patients
Kusog Baga, Philippines
“Kusog Baga,” is a Filipino Visayan term that means “healthy lungs.” The Kusog Baga (KB) Project is a TB Control and Prevention Project that builds the capacity of key stakeholders and facilitates partnerships. Phase I of the KB Project started in 1998 and operationally ended in March of 2000, covering four areas in the Philippines with a population base of 2.8 million. With 100% DOTS coverage, an 87% cure rate was achieved.
Recognizing the effectiveness of Kusog Baga Phase I (KB I), the World Vision Development Foundation (WVDF) decided to expand into more areas. Start up activities including advocacy, baseline preparation, capacity building, and purchasing of microscopes for the Phase II target areas were conducted during April 2000.
KB Phase II covered 11 target areas in 8 provinces and 9 cities and with a population of 10 million people – approximately 11% of the total Philippine population. Full implementation of KB II started on March 2001 and concluded in March 2004. In addition to supporting the RNTP, KBII also contributes several “added-value” components: capacity building; community-based health information system (HIS); community-based DOTS; quality assurance; hardware/material support; material for information, education and communication (BCC) strategies and behavioral change; operational research to determine civil society and private practitioner’s participation/involvement of the NTP and the development of a Regional TB Learning Center.
WV Canada works closely with the WVDF KB team in implementation and monitoring of KBII. The National KB team facilitates and coordinates with the WHO TB Division, the national Department of Health and CIDA (Manila). Through WV’s Area Development Program (ADP), the KB facilitators based at the provincial and municipal levels work closely with the Department of Health at the regional level, and Local Government Units at provincial, municipal, and barangay levels.
SHIFA TB Control and Prevention Project, India
SHIFA is an Urdu term for healing. Through the SHIFA project WV seeks to contribute to the healing and cure of TB patients in eight districts of the State of Andhra Pradesh with a combined population of 27 million. SHIFA supports the Revised National TB Control Program (RNTCP) of the Government of India at district and sub-district levels.
SHIFA has five key strategies:
1. Mobilize communities for action against TB and ensure
that all people in each of the 8 district have the opportunity to hear about
signs, symptoms, and available treatment services.
2. Ensure that all patients in every village within target
TB Units have a trained, quality DOT Volunteer.
3. Link Private Practitioners and Private Health Facilities
to the RNTCP; this will include linking HIV/AIDS clinics to the TB
Program.
4. Network and advocate for increased support for RNTCP DOT
Program.
5. Monitor, evaluate, and report on the success of SHIFA
and the RNTCP at district levels.
TB care groups are one of the strengths of the project. They comprise of members of the Mahila Mandals, Self Help Groups (SHGs) youth associations, local religious leaders and other important persons in the community. These groups are oriented/trained on TB symptoms and treatment and available services. Due to the active involvement of these TB care groups, there has been an increase in case detection. Some TB care group members are also DOT volunteers. It is hoped, these care groups will continue to be change agents in case detection, DOTS implementation, defaulter tracking and IEC.
For more information on World Vision TB projects:
http://www.worldvision.ca/home/programs-and-projects/international-programs/hivaids-and-tb/
XVI International AIDS Conference in Toronto
The World Health Organisation, UNAIDS, International AIDS Society, Treatment Action Group and Forum for Collaborative HIV Research are jointly organising a one and one half day international pre-conference consultative meeting entitled “HIV and TB in the context of universal access: what is working and what is not?” on behalf of the Global TB/HIV Working Group of the Stop TB Partnership. Many sessions at the AIDS conference will address the issue of HIV/TB co-infection. RESULTS Canada, with support from RESULTS Education Fund, is hosting an evening satellite session on 'Mainstreaming TB in HIV/AIDS and MDG Global Advocacy," scheduled for Thursday August 17 from 18:00 to 20:00 in SRB2. The conference programme can be accessed at:
http://www.aids2006.org/PAG/ProgrammeAtAGlance.aspx
Stop TB Canada was formed in February 2001 to support Canada in fulfilling its commitment to the targets of the G-8 Okinawa 2000 Communiqué to reduce poverty and the diseases of poverty and specifically to halve the global burden of TB by 2010.
http://www.g8.utoronto.ca/summit/2000okinawa/finalcom.htm
Stop TB Canada has the following objectives:
1. To promote and support TB
education for health care providers, decision makers and the
public;
2. To
advocate for appropriate policies, guidelines and priorities
that enhance global TB control;
3. To facilitate and encourage
communication with our members and partiers in an open and
transparent manner to advance global TB control;
4. To ensure
collaboration and co-ordination between Canadian government
departments, non-governmental organisations (NGOs), professional organisations,
the private sector and other stakeholders in the global fight against TB.
For more information on Stop TB Canada, visit:
http://www.stoptb.ca
For comments on Stop TB Canada e-News, or to submit suggestions for topics or TB articles in the Canadian news to be included in the next edition, please contact Labib El-Ali at:
labib@results-resultats.ca
Other web resources for TB news and events
· For global TB news and upcoming
events, go to the Stop TB Partnership website and click on “News, Events and
Press”: http://www.stoptb.ca
· To subscribe to the Newsletter of
International Union for TB and Lung Diseases (IUATLD) click on the “News” icon
on their website: http://www.iuatld.org/
· The US CDC also provides a weekly
TB-Update of news, journal abstracts, upcoming events, conferences and
trainings. To subscribe go to:
http://lists.constellagroup.com/mailman/listinfo/tb-update
World Health Organisation – TB
http://www.who.int/tb/en/
The Global Fund to fight AIDS, TB and Malaria
http://www.theglobalfund.org/en/
TB Global Alliance for TB Drug Development
http://www.tballiance.org/
The Aeras Global TB Vaccine Foundation
http://www.aeras.org/index.html
For global data on HIV/AIDS, TB and malaria
http://www.globalhealthfacts.org/
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The Stop TB Canada e-Newsletter is produced by Stop TB Canada with the support of RESULTS Canada.