National TB Programme Managers, partners and experts meeting to review progress on End TB milestones in South-East Asia Region

Overview

Summary recommendations of the meeting

1. Improving access to diagnostic and treatment services

a. Plan and implement intensified case-finding activities complemented with patient-support mechanisms to cover the gaps in notifications due to COVID-19 outbreak.

b. Undertake diagnostic network optimization activities for efficient use of existing diagnostic services.

c. Include Chest X-Ray followed by rapid molecular tests in diagnostic algorithms for early TB diagnosis

d. Introduce GeneXpert/XDR as soon as possible – incorporate it into diagnostic algorithms.

e. Phase out all injectable based DR-TB regimens (bar individualized regimens which require inclusion of a SLI) by the end of 2022

f. Plan asap to transition to the newer and shorter duration all-oral DR-TB regimens, including BPaLM and BPaL under programmatic conditions

g. Involve community at the planning stages of implementation and monitoring of new activities in operational research, not only monitoring the service delivery.

h. Regular dialogue between NTPs and community groups to better understand the respective partners perspective.

i. Reinvest Global Fund funds (including TB and C19RM) for screening, testing, regimen, and commodities to support adoption of newer regimens, as a cross cutting investment, in line with the C19RM scope j. Capacity building of community, and patient groups on innovations like newer TPT regimens, diagnostics, treatment, and care. k. Capacity building of health workforce on innovations like newer TPT regimens, diagnostics, treatment, and care to ensure rapid introduction of these innovations of new DR-TB treatment recommendations as per demand of countries.

2. Improving access of service for vulnerable and marginalized groups

a. Address TB among migrant workers, industries, by engagement of workplaces in both public and private sectors

b. Embark on peer education and support on TB, HIV, and migrant health camps through NGOs/employers/construction companies/ Industries/ Dormitories, as per the country situation

c. Adopt updated WHO guidelines for diagnosis and management of TB in children and adolescents.

d. Strengthen collaboration with prison services through multisectoral coordination and support of CSOs and NGOs

3. TB preventive treatment (TPT)

a. Adapt WHO recommended shorter regimen and inclusion of all risk-groups, specifically adolescent and adults for TPT in the country guidelines.

b. Adopt WHO guidelines for provision of TPT among MDR-TB contacts as per risk-benefit assessment

4. Addressing social determinants of health

a. Undertake catastrophic cost surveys in countries where it is not already conducted.

b. Strengthen multisectoral collaborations and look beyond the health sector for comprehensive access to social protection services.

5. Meaningful engagement of community

a. Develop/update guidelines to define “community engagement”. This initiative has already been taken by WHO HQ.

b. Formal and informal partner coordination forum should be further utilized for regular dialogue and strengthening collaboration.

c. Mapping of community-based organization engaged in TB work is important for each country.

d. Services of community members with relevant expertise can be used for capacity building of NTP staff on community engagement.

e. Provide capacity building training to communities for empowering them and taking right treatment decisions.

6. Private sector engagement

a. Make legal provisions for mandatory notification of all TB patients

b. Address bottlenecks for provision of enablers to patients through private sector

c. Look for innovative means for engagement of pharmacies in referral and treatment provision.

d. Consider provision of financial and non-financial incentives for private sector for referral and management of TB patients.

7. Multisectoral engagement using an accountability framework

a. Undertake baseline assessment review and progress mapping using WHO multisectoral accountability framework for TB (MAF-TB).

b. TA to be requested by Member States for MAF-TB assessment and preparation for coming UNHLM on TB reporting.

8. Update of National Strategic Plans

a. Form “Partners Coordination Forum” that includes key stakeholders and communities for planning discussions and strategies to reach out to all groups using a people centered approach.

9. Strengthen regional cooperation on research and innovation

a. SEARO to convene WHO CCs and partners for prioritizing research and strengthening South-South collaboration on research and innovation

b. Regional capacity building on planning and implementing research activities through existing and new platforms.

c. WHO-CCs to make annual plan and communicate with WHO RO, TB unit regarding fund availability per year.

10. Resource mobilization

a. All eligible countries need to start consultation dialogues to plan for the Global Fund funding request.

b. Countries also need to start preparing transitional plans for use of GeneXpert MTB/RIF Ultra, XDR-TB tests and introduction of BPaLM/ BPaL regimen. c. Engage with all partners including community groups, GDF, GF, technical agencies, WHO country offices to develop ambitious plans towards ending TB