Download New drugs uptake in WHO EURO

New drugs uptake in WHO EURO
Dr Ogtay Gozalov,
Medical officer,
WHO EURO
[email protected]
Dr Maya Kavtaradze,
Regional Technical Adviser,
Stop TB Partnership's GDF
[email protected]
Dr Elmira Gurbanova,
rGLC/Europe consultant,
[email protected]
Dr Gunta Dravniece,
Senior TB Adviser, KNCV
[email protected]
18th Wolfheze Workshops and 15th WHO National TB Programme Managers’ Meeting
The Hague, Netherlands
June 2017
Analysis of rGLC/Europe reports on
new drugs / new treatment regimens
Methodology
2016
2017
Uzbekistan
Ukraine
Turkmenistan
Tajikistan
Republic of Moldova
(Transtristria)
Romania
Moldova
FYR Macedonia
Kyrgyzstan
Serbia (UN AT
Kosovo)
Kazakhstan
Georgia
Belarus
Azerbaijan
Armenia
Year of the
assessment
18 regional GLC mission reports from 15 sites were analyzed
against elements needed to be addressed for introduction of
new TB drugs (Bdq and Dlm), as per the Policy
Implementation Package
Availability of Bdq and/or Dlm in the country
Available in Armenia, Belarus, Georgia,
Kazakhstan, Serbia (UN AT Kosovo),
Moldova, Romania, Moldova
(Transnistria), Ukraine, Uzbekistan
4
No information on Tajikistan
1
10
Not available in Azerbaijan, FYR
Macedonia, Kyrgyzstan, Turkmenistan
Out of 15 countries assessed, 10 introduced Bdq
and/or Dlm
Number of countries that introduced
new TB drugs
Cumulative number of patients receiving new
TB drugs
Bdq-based
treatment
33
8
2
2013
10
137
Dlm-based
treatment
2
2014
2015
845
2016
Bdq+Dlmbased
treatment
National implementation plan for introduction of new TB
drugs
Availability of the National Implementation Plan
5
7
3
Available in Armenia, Belarus,
Georgia, Kyrgyzstan, Moldova,
Tajikistan, Uzbekistan
No information on Kazakhstan,
Turkmenistan, Ukraine
Not available in Azerbaijan, Serbia
(UN AT Kosovo), FYR Macedonia,
Romania, Moldova (Transnistria)
Minimum requirements for country preparedness and
planning: National health context
Availability of the National Strategy to fight TB up to 2020
Available in Azerbaijan, Armenia, Belarus,
Georgia, Kazakhstan, Serbia (UN AT
Kosovo), Kyrgyzstan, FYR Macedonia,
Moldova, Romania, Tajikistan,
Turkmenistan, Ukraine, Uzbekistan
1
No information on Moldova (Transnistria)
14
Minimum requirements for country preparedness and
planning: Laboratory
Drug susceptibility testing (DST) to first-line
drugs (FLD)
Quality assurance for DST to FLD
1
1
5
9
14
Available in Azerbaijan, Armenia, Belarus, Georgia, Kazakhstan,
Serbia (UN AT Kosovo), FYR Macedonia, Moldova, Romania,
Moldova (Transnistria), Tajikistan, Turkmenistan, Ukraine,
Uzbekistan
No information on Kyrgyzstan
Passed in Azerbaijan, Armenia, Belarus, Georgia, Kazakhstan, FYR
Macedonia,Tajikistan, Ukraine, Uzbekistan
No information on Kyrgyzstan, Moldova, Romania, Moldova (Transnistria),
Turkmenistan
Not passed in Serbia (UN AT Kosovo)
Minimum requirements for country preparedness and
planning: Laboratory
Drug susceptibility testing (DST) to secondline drugs (SLD)
2
Quality assurance for DST to SLD
1
2
1
12
12
Available in Azerbaijan, Armenia, Belarus, Georgia, Kazakhstan,
Moldova, Romania, Moldova (Transnistria), Tajikistan, Turkmenistan,
Ukraine, Uzbekistan
No information on Kyrgyzstan
Not available in Serbia (UN AT Kosovo), FYR Macedonia
Passed in Azerbaijan, Armenia, Belarus, Georgia, Moldova,
Kazakhstan, Romania, Tajikistan, Moldova (Transnistria),
Turkmenistan, Uzbekistan, Ukraine
Not passed in Serbia (UN AT Kosovo), FYR Macedonia
No information on Kyrgyzstan
Minimum requirements for country preparedness and
planning: Drug supply and management
• Registration of Clofazimin (Cfz) is problematic at all countries.
• Bdq and Dlm are imported based on one-time license, mainly
because these drugs are still on a clinical trial
• TB drugs procured with the support from the Global Fund are
quality assured.
• However, drugs procured through local budget, mainly do not
hold GMP or WHO-prequalification
Minimum requirements for country preparedness and
planning: Drug supply and management
Shortage of TB drugs reported during the last 2 years
No shortage reported in Armenia,
Georgia, Kazakhstan, Serbia (UN AT
Kosovo), FYR Macedonia, Moldova,
Tajikistan, Turkmenistan, Uzbekistan
5
No information on Kyrgyzstan
9
1
Shortage reported by Azerbaijan,
Belarus, Romania, Moldova
(Transnistria), Ukraine
Minimum requirements for country preparedness and
planning: Case management
National guidelines for the programmatic management of drug-resistant TB
is updated as per the latest WHO recommendations
Updated in Belarus, Kazakhstan, Ukraine
3
No information on Kyrgyzstan
1
11
Not updated in Azerbaijan, Armenia, Georgia, Serbia (UN
AT Kosovo), FYR Macedonia, Moldova, Romania,
Moldova (Transnistria), Tajikistan, Turkmenistan,
Uzbekistan
Minimum requirements for country preparedness and
planning: Monitoring and evaluation
• All countries use updated WHO definitions for TB (2013 update)
• Some countries still do not have functional electronic TB database
and execute paper-based reporting (Azerbaijan, Tajikistan,
Turkmenistan, Uzbekistan, Kyrgyzstan)
• Supportive supervisions in majority countries are performed by the
National TB Programs, but are heavily relying on the Global Fund
support
Minimum requirements for country preparedness and
planning: Pharmacovigilance
• Armenia, Belarus and Georgia established:
– Active pharmacovigilance (PV)
– Centralized PV data collection
– Cohort-event monitoring used as PV method
• In remaining 12 countries the PV is not duly
implemented
New and companion drugs via
GDF
Access to New TB tools via
Global Drug Facility
and reporting requirements
Global Drug Facility (GDF)
An enterprise of the Stop TB Partnership, mainly funded by USAID, hosted in
UNOPS and managed by the Partnership secretariat
GDF Goal: Facilitate equitable and timely access to affordable, quality-assured,
medicines and diagnostics, including new tools.
GDF began supplying FLDs in 2001, and in 2007 added
the supply of SLDs, pediatric TB medicines and
diagnostics and is a major source for GeneXpert™
GDF order placed by Product Line
137 countries benefited from GDF procurement / bundled
mechanism
> 27 M Adult FLDs treatments
> 1,59 M pediatric treatments
> 239,321 SLDs patient treatments
US$ 1.63 billion of TB commodities procured since GDF inception
in 2001
(as of December 2016)
www.stoptb.org
The Product List and Catalogue http://www.stoptb.org/gdf/drugsupply/drugs_available.asp
New Diagnostics
www.stoptb.org
www.stoptb.org
Access to Laboratory and Diagnostic Products
All products for WHO’s recommended techniques including New rapid diagnostic and DST tests!
Equipment and accessories, diagnostics and consumables, microbiological
tests and test systems for:
GDF diagnostics catalogue
•
Equipment Kit for Microscopy laboratory Diagnostics and consumables
kits for ZN or Auramine staining techniques
•
Liquid Culture and DSTs Becton Dickinson BACTEC MGIT 960 system
MGIT Tubes, OADC Supplement, SIRE Kits and Rapid Diagnostic Test SD
BIOLINE TB Ag MPT64
•
Lyophilized drug for laboratory use (Amikacin, Capreomycin,
Kanamycin, Moxifloxacin, Ofloxacin)
•
Solid culture and DST Loewenstein-Jensen-Medium
•
• Lifescience
TB LAMP (Loopamp technology)
Molecular line probe assays for 1st-line anti-TB drugs HAIN
• Digital X-Ray
GT-Blot 48, Twincubator, GenoType MTBDRplus and services
• DNA Genotek - OMNIgene•SPUTUM (OM-SPD)
Automated real-time nucleic acid amplification - Xpert MTB/RIF system
• Quiagen - QuantiFERON-TB Gold Plus (QFT®-Plus)
Laboratory instruments, consumables, chemicals and personal
protective equipment
•
•
Product coming to GDF portfolio in 2017
TM
www.stoptb.org
www.stoptb.org
Access to WHO-recommended medicines
Full range of medicines for any type of TB treatment regimens available from the GDF!
Repurposed medicines with increasing demand: Clofazimine,
linezolid, amoxicillin clavulanate, imipenem/cilastatin
Products price list online
Substantial price decrease for: Linezolid
Price decrease for: Amoxicillin Clavulanate, Capreomycin,
Imipenem/Cilastatin, Levofloxacin, Moxifloxacin and PAS Sodium
Salt
Clofazimine 100mg from Novartis
Off label use in TB - disclaimer and quarterly A second
manufacturer is expected in 2017
Application for inclusion in the WHO EML -March 2017
New dispersible pediatric formulations
2-FDC/RH-75/50; 3-FDC/RHZTreatment of Latent Tuberculosis Infection
75/50/150
Priftin® (rifapentine 150 mg tablet) from Sanofi
www.stoptb.org
www.stoptb.org
New GDF Strategic Rotating Stockpile (SRS): aimed
Improve the service level to GDF clients:
•
•
Decrease lead time between the countries’ orders and delivery by
serving countries from available stock
Ensure flexibility of supply in case of over stocking or stock-out
situations in countries: Adapt client orders with consumption by
pre or postponement of deliveries
Improve the service level to GDF suppliers :
•
•
•
Improve the GDF order cycle by a better scheduling of orders to
suppliers
Adapt replenishment orders and production capacity to smooth
peaks in the ordering pattern
Provide to suppliers more reliable forecast and information on
the market especially on policy changes
to
SRS Product Name
Amikacin 500mg/2ml injectable
Amoxicillin 500mg+Clavulanic acid 125mg
Amoxicillin 875mg+Clavulanic acid 125mg
Bedaquiline 100mg tablet
Clofazimine 100mg capsule
Capreomycin 1gram powder for injectable
Cycloserine 250mg capsule
Delamanid 50mg tablet
Ethionamide 250mg tablet
Kanamycin 1g injectable solution
Levofloxacin 250mg tablet
Levofloxacin 500mg tablet
Linezolid 600mg tablet
Moxifloxacin 400 mg tablet
PAS sodium sachet
Prothionamide 250 mg tablet
Pyrazinamide 400 mg tablet
Pyrazinamide 500 mg tablet
Syringe & needle (auto-disabling)
Water for injections
Isoniazid 300mg tablet
Ethambutol HCI 400 mg tablet
www.stoptb.org
GDF value-adding package of services
Delivering-only does not work any more
The Goal of the GDF Technical Assistance and Capacity Building Strategy is twofold
• To strengthen priority countries capacity to ensure timely equitable access to the GDF-supplied quality-assured
medicines and products, including new TB products
• To provide country information and evidence on TB product demand and country TB control trends for the GDF strategic
procurement planning and decision-making, and global forecasting exercises
www.stoptb.org
GDF TA and Capacity Strengthening
GDF tier 1 countries with core USAID support
Tier 2 countries with additional USAID support
Full package TA for expedited uptake of new TB tools
managed by Regional Technical Advisors
Managed by GDF HQ and RTAs
Implemented by pool of GDF-trained consultants
•
•
•
•
•
Development of Transition PSM plans
Assistance with functional EWS for monitoring uptake
Ongoing focused technical assistance and capacity
building for PSM systems strengthening
PSM tools implementation: QuanTB (quantification,
planning, Early Warning), data collection tools
GDF Regional Technical Advisers:
Zaza Munez – SE Asia and W.Pacific [email protected]
Salama Mwatawala – Africa [email protected]
Maya Kavtaradze – Europe/CAR [email protected]
Erulappa Thanaraj – India [email protected]
Targeted TA for PSM plans of the Global Fund
proposals
• Development of Transition PSM plans for new TB tools
• Regional capacity building for forecasting and
quantification
• Assistance with functional Early Warning System
• Joint missions: rGLC, TGF, WHO, partners (e.g. KNCV,
UNION, etc.)
Two additional RTAs to be hired for
• Best practices and knowledge sharing
Africa (Anglophone/Francophone)
SE Asia
Pool of trained regional consultants
www.stoptb.org
www.stoptb.org
New TB tools
Shorter MDR-TB treatment regimen
New Paediatric Formulations
New and repurposed drugs
New diagnostics
www.stoptb.org
Bedaquiline 100 mg tablest
Sirturo by J&J, Kemwell Biopharma, USFDA/EMA
Packing size: HDPE container(s) of 188
Shelf life: 36 months
USAID Bedaquiline Donation Program: free-of-charge to
eligible countries following WHO interim recommendations
As of April 2017: 10 705 treatment courses globally
including MSF projects (delivered, orders placed with
suppliers or in process)
Of which in Europe and CAR countries: 2 944 courses without
MSF projects
Country
Countries can request
Technical Assistance from
USAID and GDF
([email protected] ;
[email protected];
[email protected])
Adverse events reported directly to Janssen or
via GDF: [email protected]
Armenia
Azerbaijan
Belarus
Georgia
Kazakhstan
Kosovo
Kyrgyzstan
Republic of Moldova
Tajikistan
Turkmenistan
Ukraine
Uzbekistan
Grand Total
BDQ Order
placed with
supplier
BDQ Order
Completed
BDQ Total
69
386
341
390
25
89
50
90
1440
91
139
60
332
2
110
67
70
40
200
393
1504
69
91
525
401
722
2
135
156
120
40
200
483
2944
www.stoptb.org
www.stoptb.org
Delamanid 50mg tablets
Deltyba by Otsuka, EMA/Japan
Packing size: Box(s) of 672
Shelf life: 60 months
Countries eligible for TB Financing by The Global Fund and
following WHO interim recommendations can access
Delamanid via the GDF
Price USD 1,700 for a full treatment course (6 months)
Adverse events reported to Otsuka via the GDF:
[email protected]
As of April 2017: 2 448 treatment courses globally
including MSF projects (delivered, orders placed with
suppliers or in process)
Of which in Europe and CAR countries: 626 courses
without MSF projects
Country
Armenia
Azerbaijan
Belarus
Georgia
Kazakhstan
Kosovo
Kyrgyzstan
Republic of Moldova
Tajikistan
Turkmenistan
Ukraine
Uzbekistan
Grand Total
DLM Order
Completed
DLM Order placed
with supplier
DLM Total
MSF
144
35
130
193
80
337
35
210
8
25
8
25
MSF
309
11
317
11 + MSF
626
www.stoptb.org
www.stoptb.org
How to Access Bedaquiline and Delamanid via GDF (1)
A. Countries/programs should ensure they follow the five WHO
recommendations for optimal introduction of BDQ and DLM:





Effective treatment and monitoring
Proper patient inclusion
Informed consent
Adherence to WHO recommendations
Active pharmacovigilance and management of adverse events aDSM
─ Active and systematic clinical and laboratory assessment of patients on treatment with
new anti-TB drugs, novel MDR-TB regimens or XDR-TB regimens to detect, manage and
report suspected or confirmed drug toxicities and adverse events;
─ Systematic and standardized recording and reporting at least Serious Adverse Events
(may also monitor other AEs that are of clinical significance or of special interest to the
program and can be expanded to eventually cover TB patients on treatment with any
second-line drugs)
aDSM is intended
─ to be an integral component of the programmatic management of drug-resistant TB
(PMDT) and
─ to complement current capacities of national pharmacovigilance.
www.stoptb.org
How to Access Bedaquiline and Delamanid via GDF (2)
B. Review the background documentation on the
program and the order form from the GDF
(http://www.stoptb.org/gdf/drugsupply/procurement_forms.asp)
System for systematic
and standardized
recording and reporting
of AEs is required
Annex: Adverse Drug Reaction / Serious
adverse event forms
•
•
BDQ Adverse events reported to Janssen via GDF: [email protected]
DLM Adverse events reported to Otsuka via the GDF:
[email protected]
www.stoptb.org
www.stoptb.org
How to Access Bedaquiline and Delamanid via GDF (3)
C. Estimate the number of patients who will benefit from the
Out- and in-coming medicines
medicines:
Dlm Cs
BdqEto
Cm
Pto
─ Planning and executing the supply for multiple concurrent new and
Am
Imp AmCl
PAS
Cfz
Km
Mfx
Lnz
old regimens of different duration and at various implementation
Lfx
Z
start dates
─ Mixed supply medicines in countries graduating from the GF support:
 Forecasting and quantification for multiple regimens become too complex for the
maintaining quality and access
existing level of expertise
Increased individualization and number of treatment regimens
D. Review
the need
for other second-line
drugs that
are
 Lack
of data-driven
rational phase-in
/ phase-out
transition planning with scenarios
Standard M/XDR 20 month:
needed toand
treat
patients
who will be receiving BDQ or
cost
estimations
8Cm70%Km30%Lfx50% Mfx50% Pto90%Cs90% PAS60%Z100%/12Lfx50%
DLM
Mfx50% Pto90%Cs90% PAS60%Z100%
 Need for functional Early Warning System including
patient data collection to
With new and repurposed drugs 20 months:
─ data-driven need-based approach to forecasting /
manage transition without treatment interruptions
6Bdq90%/6Dlm30%/8Cm65%Imp\Cls35%Amx\Clv35%Cfz90%Lnz90%Mfx50%L
quantification for all medicines (not cohort-based)
─ Phase-in / phase-out planning: scenarios and
estimation of volumes and values of obsolete
medicines for withdrawal and destruction
E. Review needs based on the above descriptions
fx10% Pto30%Cs30%PAS4% Z50% /12Cfz90%Lnz90%Mfx50%Lfx10%
Pto30%Cs30%PAS4% Z50%
STR 9 - 12 months (composition and duration may vary):
(4-6)Km10% Cm80% Am10%Mfx20% Pto100% Cfz100% Hh100% Z100% E100% /(5
-6) Mfx100% Pto100% Cfz100% Z100% E100%
www.stoptb.org
Quantification and Early Warning System
Benefits from EWS (quarterly QuanTB reports):
•
Proactively monitor TB medicines supply and medicines orders: Early
action to prevent stock-out/overstock
•
Streamline medicine orders: Firm order schedules, streamlined supply to
countries
•
Ensure uninterrupted supply for smooth transition to new medicines and
regimens
•
Play scenarios for rational introduction of new TB tools
•
Reduce wastage of medicine: in-country reallocation of medicines where
possible and changing delivery schedule - GDF needs advance notification!
•
GDF will improve global and strategic procurement forecasting (Cheaper
medicines for countries)
•
Reports will also serve as foundation for evidence-based technical
assistance to countries for rapid and rational transition to new medicines
and regimens
www.stoptb.org
www.stoptb.org
How to Access Bedaquiline and Delamanid
via GDF (4)
F. Place order for new and other second-line drugs as the turn-around time is
likely to be several months, and TA activities can be carried out while awaiting
drug arrival:
─
Need to capacitate laboratories to conduct SL DST (LPA, automated,
conventional)
─
Development, approval and introduction of new treatment guidelines and
training of staff at all levels
─
Need for approved policy for expedited uptake of new medicines and
regimens, including for withdrawal and destruction of obsolete sub-optimal
medicines
•
•
•
•
•
Delays in initiating orders…
Delays in approving quotes…
Delays in country to grant
dispatch authorization…
Last minute changes in
required shipping
documents....
Delays in country to import
through customs, stock and
deliver…
G. Explore options to import new medicines in the country if they are not
registered yet:
─
Registration/waivers and importation approvals (Donor and Domestic
funded)
H. Review clinical cases and patient histories to see who would benefit from new
medicines.
www.stoptb.org
www.stoptb.org
Message from WHO and GDF to NTP’s:
1.
2.
3.
4.
All Medicines and diagnostic tools recommended by WHO, including STR
and new drugs are available in GDF
Technical assistance and capacity strengthening for the introduction of new
TB tools are available through the GDF and USAID-funded projects
NTPs should use current opportunities and should not delay the transition of
use of new TB drugs, STR and new pediatric formulations
NTPs are requested to follow reporting requirements including ADRs and
EWS reports
www.stoptb.org
Introduction of new drugs and
shorter DR-TB treatment regimen
KNCV’s approach
Gunta Dravniece, Michael Kimerling
KNCV
Wolfheze conference, May 31-June 2 2017
KNCV supports
programmatic introduction and evaluation
of any innovation
• Diagnostics
• Regimen design
• Monitoring of safety
and efficacy
Monitoring
• Drug management
• Patient support
• Infection control
• Recording & reporting
• Digital health
KNCV’s patient triage approach allows initiation of the most
effective treatment regimen for
any TB patient in <5 days
Patient with presumptive TB
Rapid molecular test
(e.g. Xpert MTB/RIF)
No TB
Rif susceptible TB
Rif resistant TB
START TREATMENT AFTER EVALUATION OF
ELIGIBILITY FOR SHORTER REGIMEN
Appropriate
referral/ treatment
Standard TB
treatment with First
Line Drugs
Eligible
Shorter DR-TB
treatment regimen
Ineligible
Individualized DRTB treatment
regimen
Patient Triage Approach
Linking the
Bdq donation program
with introduction of the
STR
KNCV’s support in WHO Euro
Through USAID Challenge TB project
(CTB)
Four countries in the region
• Ukraine (PATH and KNCV)
• Uzbekistan (WHO and KNCV)
• Kyrgyz Republic (KNCV)
• Tajikistan (KNCV)
Generic documents developed and
adapted for country needs
1. Implementation planning tool
2. Programmatic and clinical guide
3. Job aids (Use of Bdq; QTE)
4. Generic SOPs (under development)
5. Generic Training materials (under development)
COUNTRY SUPPORT:
EXAMPLE FROM KYRGYZ
REPUBLIC
Regulatory environment and policy I
1.Advocacy work resulted in support from MoH
2. Use of new drugs included in national guidelines
3. National plan for new drugs and regimens
developed and endorsed by MoH
Regulatory environment and policy II
4. Triage approach and implementation of proposed regimens
supported by inter-/national partners
5. Adverse event monitoring within MDR-TB program was revised
and linked with PV authority
Site preparation I
1. One functional diagnostic algorithm designed
and includes Xpert and HAIN SL tests
2. Specimen transportation, procurement of
consumables supported
by other partners considering
KNCV approach
3. UNDP/GF supports triage approach – drugs
shorter and individualized regimens
procured
for
Site preparation II
1. Clinical guide and SOPs developed
2. Access to all necessary monitoring tests
supported
by UNDP/GF in coordination with KNCV
3. Electronic data base developed
4. Training
for clinical and laboratory staff
5. Patients’ enrolment
new drugs
6. Continuous
provided
for shorter regimen and regimen with
started in January 2017
on job training and supervision
provided
44
Introduction timelines in Kyrgyz Republic
•
•
Adjustment of
guidelines
Design of
diagnostic
algorithm and
treatment
regimens
Q3
2015
•
•
•
Q4
2015
Site selection/assessment
Development of National
plan
Estimation of drug needs
•
Developmen
t of guide
Q1
2016
•
Development
of SOPs
Endorsement
of National
plan
Q2
2016
Q3
2016
•
•
•
•
On job
training
Patient
enrollment
Q4
2016
Finalization of guide and SOPs
Training of clinical and
laboratory staff
Enrollment started in January 2017
Short treatment regimen is introduced starting from two sites
(Bishkek city, Chui oblast)
•
58 patients enrolled, including 3 children and 7 adolescents
Individualized regimen containing new and repurposed drugs
is provided for patients from whole country.
•
58 patients enrolled, majority from the waiting list, many of them in
severe condition at the time of enrollment
Progress in other countries
Tajikistan
• Enrollment started in December 2016
• By the end of April 2017 24 patients enrolled in shorter
regimen and 24 in individualized regimen
Ukraine
• Bdq ordered for 200 patients
• Enrollment will be started in June 2017
Uzbekistan
• CTB project just started
• Guidelines adjusted
• National plan developed
Lessons learned from CTB countries I
1. Treatment regimen is only one of components in patient
management. TA should address the essential PMDT elements
Diagnost
ics
2. Many PMDT components were not ready in countries
therefore preparationTreatme
takes longer (around 12 months).
nt
monitori
ng
3. TA on ND&R provides an opportunity to strengthen MDR
program.
4. Political support is crucial
Treatment
regimen
Lessons learned from CTB countries II
5. Preparing national plan helps to identify all components and
dividing tasks among partners
6. Preparation of introduction sites should be simultaneous
Diagnost
with preparations at national level
ics
7. Specific needs for children
Treatme and adolescents with TB should be
considered
nt
monitori
ng
Treatment
8. Coordination with partners is essential
regimen
•
Common approach
•
Coordinated procurement
•
Complementary activities
Acknowledgements
KNCV
•
Susan van den Hof
•
Agnes Gebhard
•
Ieva Leimane
•
Nick Blok
•
Maria Idrissova
•
Bakyt Myrzaliev
•
Sandra Kik
•
Edine Tiemersma
•
Fraser Wares
•
Job van Rest
•
Hadi Qawasmeh
•
Marcela Tommasi
•
Michael Kimerling
PATH
•
Katya Gamazina
•
Olga Pavlova
•
Nina Zherebko
•
Aleksey Bogdanov
Acknowledgements
• rGLC/Europe
members and
consultants
• NTP’s of Member
States
• Stop TB partnership
GDF
• KNCV and Challenge
TB Project
• MSF