2002-06-28-世界卫生组织-Report_of_the_2nd_Meeting_of_the_Strategic_and_Technical_Advisory_Group_for_TB_16页_666kb

Summary of the Second Strategy and Technical Advisory Group for Tuberculosis Meeting (2002)

Core Content

The Second Strategy and Technical Advisory Group for Tuberculosis (STAG-TB) meeting took place in Geneva from June 26 to 28, 2002. The group, composed of 18 members, provides independent scientific and technical guidance to the World Health Organization (WHO) on tuberculosis (TB) control. The meeting aimed to evaluate the progress of global TB control efforts, review regional strategies, and make recommendations for future actions.

Main Objectives and Recommendations

Objective 1: Review of WHO Regional Plans for TB Control

• STAG-TB acknowledged the success of regional and country teams in developing DOTS expansion strategies.
• Recommended further standardization of regional presentations to enable better cross-regional comparisons.
• For the African region, suggested revising targets and sub-regional analysis, prioritizing high-burden countries, and improving health system coordination.
• For the American region, recommended data analysis on antiretroviral use and TB incidence in Brazil, and focusing on high-burden and DOTS-challenged countries.
• For the Eastern Mediterranean region, suggested collaboration with WHO headquarters to resolve human resource constraints and the development of "toolkits" for improved practice.
• For the European region, recommended a focus on DOTS expansion in Eastern Europe and Central Asia, enhancing political commitment, and improving laboratory networks.
• For the South-East Asia region, recommended testing case detection measures and conducting prevalence surveys in large countries.
• For the Western Pacific region, suggested exploring interagency coordination models and developing an NGO-government application for financing private sector DOTS networks.

Objective 2: Review Progress Towards 2005 and 2010 TB Control Targets

• The TB Monitoring & Evaluation (TME) unit was commended for its analysis showing that case detection may plateau at around 40% of smear-positive cases globally.
• STAG-TB recommended forming a task force to analyze the reasons for slow progress and provide guidance on reprioritization.
• Suggested further analysis of the relationship between progress and changes in prevalence, mortality, and incidence.
• Encouraged documentation of successful practices in case detection and the inclusion of case studies for less successful experiences.
• Emphasized the need for explicit policy endorsements from relevant WHO departments.

Objective 3: Report on DOTS Implementation and Expansion

• STAG-TB endorsed WHO's leadership in DOTS expansion and recommended avoiding overly conservative financial estimates.

Objective 4: Financial Monitoring Project

• STAG-TB supported the development of TB financing models and tools.
• Recommended careful consideration of diverse budgeting environments and data collection periodicity.

Objective 5: Coordination of the Global Working Group on TB/HIV

• STAG-TB supported WHO's role as Secretariat for the TB/HIV Global Working Group.
• Recommended preparation of a draft resolution for the 2003 World Health Assembly and building the evidence base on coordinated care models.

Objective 6: Guidelines for Phased Implementation of TB/HIV Collaborative Activities

• STAG-TB endorsed the need for finalizing and disseminating guidelines.
• Recommended publishing the guidelines in two parts and incorporating field examples and professional formatting.

Objective 7: Human Resources Development

• STAG-TB endorsed the strategic approach to human resource development.
• Recommended collaboration with technical assistance partners, securing financing, and examining staff retention strategies.

Objective 8: TDR Strategic Emphasis for TB Research

• STAG-TB supported TDR's role in TB research but cautioned against its involvement in basic research in developed countries.
• Encouraged collaboration with STB to develop a TB research agenda and strengthen research capacity.

Objective 9: TB Control in Changing Health Systems

• STAG-TB commended the guidelines on TB control in changing health systems.
• Recommended rapid dissemination, expanded field applications, and inclusion of case studies for unresolved issues.

Objective 10: Revised Guidelines for National TB Treatment Programs

• STAG-TB recommended maintaining continuation regimens and distinguishing WHO Category I and III treatment groups.
• Suggested examining drug resistance in failure cases and setting prerequisites for case management and MDR-TB treatment.

Objective 11: Comprehensive Programme Monitoring During Country Visits

• STAG-TB supported the development of monitoring guidelines.
• Recommended clarifying objectives, maintaining DOTS components, using routine data, and assessing the validity of indicators.

Objective 12: Global Strategy for Private Practitioners in DOTS Expansion

• STAG-TB endorsed the PPM-DOTS strategy and recommended estimating private sector "market share" through prevalence surveys.
• Suggested improving documentation on PPM impact, examining performance motivators, and assessing private sector engagement models.

Objective 13: Drug-Resistant TB Surveillance and Proficiency Testing

• STAG-TB supported the use of national standards for managing drug-resistant TB.
• Recommended presenting drug-resistant TB data in both absolute numbers and rates, and following international transport rules for strains.

Priority Topics for 2003

1. Global advocacy efforts
2. Follow-up on TB/HIV and beyond Africa
3. Quantitative evaluation of PPM efforts
4. Human resources development
5. Surveillance and strategies for case-finding
6. Contribution of community-based organizations to case-finding
7. Operational research agenda and practice
8. GFATM funding and results

Next Meeting and Membership

• The next STAG-TB meeting is planned for June or July 2003.
• WHO will provide a plan for the rotation of STAG-TB membership.

STAG-TB Members

• Dr Francis Adatu-Engwau (Uganda)
• Dr Martien Borgdorff (Netherlands)
• Professor Fadila Boulahbal (Algeria)
• Dr Jaap F. Broekmans (Chairman, Netherlands)
• Dr Peter Godfrey-Faussett (United Kingdom)
• Dr Anthony D. Harries (Malawi)
• Ms Teresa J. Ho (Philippines)
• Dr Philip Hopewell (United States)
• Dr Jim Yong Kim (United States)
• Dr P.R. Narayanan (India)
• Dr C. Guerra de Macedo (Brazil)
• Dr Rick O'Brien (United States)
• Dr Mariquita J. Mantala (Philippines)
• Dr Sheela Rangan (India)
• Dr Refiloe Matji (South Africa)
• Professor Peter M. Small (United States)

Temporary Advisers

• Ms Christy Hanson (World Bank)
• Dr Gijs Elzinga (Netherlands)

Observers

• Dr Jeffrey Starke (United States)
• Dr Charles Wells (CDC, United States)

WHO Staff

AFRO

• Dr Eugene Nyarko (Zimbabwe)
• Dr Wilfred Nkhoma (Zimbabwe)
• Dr Daniel Kibuga (Zimbabwe)
• Dr Giuliano Gargioni (Uganda)
• Dr Jan van den Hombergh (Ethiopia)
• Dr Bah Keita (Côte d'Ivoire)

AMRO

• Dr Rodolfo Rodriguez Cruz (USA)
• Dr Dionne Patz (USA)
• Dr Mario Martinez (Brazil)

EMRO

• Dr Akihiro Seita (Egypt)
• Dr Samiha Baghdadi (Egypt)
• Dr Laura Gillini (Egypt)
• Dr Emanuele Capobianco (Afghanistan)
• Dr Giampaolo Mezzabotta (Afghanistan)

EURO

• Dr Richard Zaleskis (Denmark)
• Dr Yelena Yurasova (Denmark)
• Dr Gombogaram Tsogt (Kazakhstan)
• Dr Wieslaw Jakubowiak (Russia)
• Dr Kestutis Miskinis (Ukraine)
• Dr Hans Kluge (Russia)

SEARO

• Dr Jai P. Narain (India)
• Dr Nani Nair (India)
• Dr Reuben Granich (India)
• Dr Emanuele Pontali (India)
• Dr Pierpaolo de Colombani (India)