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the Global Fund to fight AIDS, Tuberculosis and Malaria
10 June 2015

Global Fund News Flash

Stop TB Launches Online Consultation for Global Plan

The Stop TB Partnership launched an online consultation process today to engage a wide group of stakeholders in developing the Global Plan to Stop TB 2016-2020. The development of the Global Plan seeks to be as inclusive as possible, and the online consultation (http://stoptbplan2020.org/) aims to reflect a diverse range of input, including the voices of people, professional groups and TB constituencies who may not have been reached previously. The consultation process will run from 10 June to 10 August 2015. Participants are encouraged to provide comments based on top line questions.

Since its creation, the Stop TB Partnership has issued five and ten-year Global Plans for concerted global advocacy actions, and to provide an estimate for the resources needed to reach the WHO End TB Strategy goals by 2035. The current Global Plan provides a ‘business case’ for the period 2016-2020. It is meant as an instrument for those working with TB and those allocating funding.

The Stop TB Partnership said that to achieve WHO’s End TB Strategy goals, significant changes need to be made in the way most countries organize and run their TB interventions and programmes. An acceleration in research and development of new drugs, diagnostics tools and a vaccine is also imperative, it said.

In addition to the online consultation, the Global Plan to Stop TB 2016-2020 will be informed by the outcomes of four regional consultation meetings. The Global Plan will be launched at the end of the year in Cape Town, South Africa, during the 46th Union World Conference on Lung Health.

New Effort to Expand Viral Load Testing

Viral load testing is the best way to know if a child is HIV positive. It’s also a powerful tool to determine if HIV drugs are working. The problem is that until now, the tests were often prohibitively expensive and contract terms varied.

New agreements struck between the Global Fund and seven diagnostic manufacturers aim to change that. After a year of in-depth negotiation and intense study of the market, the Global Fund sourcing team believes it’s found a route to affordable and stable prices, better contracting, and hopefully, expanded testing.

The manufacturers have agreed to provide the test components at a stable and competitive all-inclusive price as low as US$15 per test, which includes the cost of testing equipment. Today, tests can cost as much as US$85.

A more competitive price is welcome, but Christopher Game, the Global Fund Procurement head, explained that it’s not the only benefit of the agreement.

“What we were really after was transparency and reliability,” Game said. “So yes, the price reduction is great, because it will free up money to do more testing. But just as importantly, we now have transparency around the various components of that price, such as transport and machine maintenance.”

The machines required for the tests don’t come cheap, selling for around US$150,000. By stabilizing the other elements required to test, Game and his team expect to see an expansion in the number of tests done.

The agreement should deliver net savings of at least US$30 million over three years to the Global Fund, and potentially much more. Seven manufacturers have been through a technical and commercial evaluation before being added to the panel of suppliers. The framework agreements last at least three years. Other public health funders and agencies will also be able to enter into agreements based on the benchmark prices and contracting negotiated.

Strategy Review

An independent group of health and development experts has presented its preliminary findings and initial recommendations of the Strategic Review 2015, the document that will provide valuable input into the Global Fund partnership’s next five-year strategy, for 2017-2021. After conducting 16 country case studies and assessing impact in another 27, the Technical Evaluation and Reference Group, known as TERG, focused the Strategic Review on key areas including resilient health systems, sustainability, human rights and gender, partnerships, differentiation and national capacity building. The findings will be presented to the Strategy, Investment and Impact Committee meeting next week. A final report is due by mid-August. The Global Fund Board will receive the full report in November. The Strategic Review has two main objectives: One is to review progress in strategy implementation to date of the 2012-2016 Strategy; the second is to assess impact against the three diseases over the past 10 to 14 years.

Tracing TB patients in South Africa

On a rainy morning in Mitchell’s Plain, a township near Cape Town, Community Care Worker Songezwa Matrose sets out to check on a client she’s been assigned— a former prisoner with TB, released the day before from Pollsmoor Detention Center’s Juvenile section. Her first challenge is just to find his house. Names of lanes and passageways here are few, and houses are numbered arbitrarily, if at all.

“Sometimes it takes hours just to find my client,” says Songezwa, who is from Mitchell’s Plain herself, and began doing contact tracing for TB patients more than a year ago, under a program managed by the South African NGO TB/ HIV Care.

Men and women held in South Africa’s overcrowded prisons have been pinpointed as a group at high risk of tuberculosis, because of the densely populated communities they often come from, as well as the close quarters within prisons. Risk of infection with TB increases exponentially as air-borne bacteria can be passed on by a mere cough in a crowded room. In the past, many who were diagnosed with TB were lost to follow-up or never told their test results because of the processing time for a test, and the difficulty of follow-up once they left prison.

In collaboration with the Ministry of Health and TB/ HIV Care, Pollsmoor Detention Center’s Health System is working to tackle this problem head on, both while prisoners are inside, and through follow-up after they are released. TB HIV Care workers within the hospital screen and test detainees, with results available in two hours since state of the art GeneExpert machines were installed in 2013. Their colleagues on the outside - Community Care Workers like Songezwa - receive contact information for TB-infected prisoners as they are released so they can facilitate adherence to treatment.

They have a critical role to play: On this day her client, Abonga Mfanta had returned home to his grandfather, mother, girlfriend and brothers and sisters—eight in all under one roof. Abonga was started on DOTS treatment for TB during his six weeks in prison, and to continue with the treatment, it’s essential that he goes to the clinic where he’s been referred.

“I did get stressed at that time,” says Abonga about the moment he heard his diagnosis from a TB HIV Care volunteer inside the prison. “I told myself ‘I’m here in prison, now I’ve got TB… I was afraid, but they tell me I’m going to be OK.”

During the 45 minutes that Songezwa spends with the family, she verifies whether anyone else in the household is showing symptoms of infection. She talks with Abonga about the next steps for his DOTS treatment, and provides him a referral to the Town 2 Clinic, a 5-minute walk from his home. With evident relief Abonga agrees that he’ll go the following day, having been given only a few days’ supply of TB treatment by the prison upon his release. He’s been advised that failure to adhere could have dire consequences—failure to be cured, developing drug resistant TB, even dying of the disease.

For Songezwa, Abonga is one of up to 40 homes she’s visiting at any given time in the community. She'll continue her visits at least once a week up to the six month treatment completion date, where with ‘normal’ TB he should be fully cured. Her attention to the family is not only a plus because of her knowledge about TB; it’s also the calm and winning smile, the in-charge manner and her dedication to the community that shines through.

By the Numbers

Honduras is on track to achieving zero new cases of P. falciparum -- the deadliest form of malaria -- by 2017. Thanks to projects with a strong involvement of local communities, malaria cases dropped 78 percent between 2000 and 2011.

The Philippines is also edging closer to elimination, with confirmed cases of malaria down by 90 percent from more than 48,000 in 2003 to 4,900 in 2014. Malaria deaths fell from 162 to 8. The National Plan targets elimination by 2030.

Copyright © 2015 The Global Fund to Fight AIDS, Tuberculosis and Malaria, All rights reserved.

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