2011-02-14-世界卫生组织-WHO_Strategic_and_Technical_Advisory_Group_for_Tuberculosis_STAG-TB_40页_454kb

WHO STRATEGIC AND TECHNICAL ADVISORY GROUP FOR TUBERCULOSIS (STAG-TB) ELEVENTH MEETING REPORT SUMMARY (6 JUNE 2011–22 JUNE 2011, GENEVA, SWITZERLAND)

1. Context and Objectives:
   The STAG-TB meeting critically assessed WHO's Stop TB Department and global TB control policies, with a focus on:

2. Department restructuring and operational priorities;

3. MDR-TB management implications under new funding frameworks;

4. Implementation of Xpert MTB/RIF molecular diagnostic technology;

5. Updating operational definitions due to novel diagnostics;

6. Advancing guidelines for TB screening and early detection;

7. Scaling up community care and civil society engagement;

8. Improving TB care in emergency settings;

9. New drug development policy mechanisms;

10. Strategy revision for post-2015 goals.

11. Key Recommendations:

I. Department Restructuring and Resource Mobilization:

• STAG-TB strongly endorsed restructuring efforts but urgently cautioned about funding cuts for the Stop TB Department and expressed concern over the limited ability to meet the ambitious 2015 targets given this reduction. The group urged resource mobilization reforms and a targeted advocacy campaign for MDR-TB management scale-up.

II. MDR-TB Management Framework:

• The group fully endorsed the new Global Framework To Support Scale Up To Universal Access To Quality Management of Multidrug-Resistant Tuberculosis but stressed the urgent need for sustained financial resources. Key recommendations included:
  • Developing a global advocacy plan to secure MDR-TB scale-up funding;
  • Accelerating the access to affordable quality-assured second-line drugs and exploring humanitarian/pharmaceutical partnerships;
  • Forming partnerships with Global Fund to improve streamlined funding mechanisms.

III. Implementation of Xpert MTB/RIF:

• STAG-TB welcomed the rapid progress but called for evidence-based operationalization with stronger mechanisms for capacity building, monitoring the impact of algorithm changes, and linkage with drug resistance surveillance. The group emphasized country-level integration within existing laboratory networks.

IV. Updating Definitions of TB Cases and Outcomes:

• STAG-TB recommended simplifying MDR-TB outcome definitions and establishing a consultative mechanism to update TB definitions. They noted the importance of retaining routine smear microscopy data for trend monitoring.

V. TB Screening Guidelines and Early Detection:

• STAG-TB advocated for systematic reviews and coordination between TB and other control programs when designing active case finding approaches. The group emphasized systematic research, community-based approaches, but cautioning against mismanagement, particularly in emergency settings.

VI. Civil Society Engagement:

• STAG-TB urged WHO to expedite its efforts in improving guidance simplicity and standardizing monitoring mechanisms for civil society organizations (CSOs). Recommendations included broader stakeholder engagement and local NGO capacity building.

VII. TB Management in Unstable Populations:

• STAG-TB encouraged EMRO to convene stakeholders to review emergency-specific TB response challenges, impact of WHO guidelines, and logistical gaps.

VIII. New TB Drug Approval and Use:

• STAG-TB endorsed the development of a drug policy roadmap and recommended engagement with regulators to facilitate timely approvals of promising new drugs and rational use frameworks.

IX. Stop TB Strategy Revision:

• Admonishing against confusion of strategies, STAG-TB recommended updating the strategy document, defining broader multisectoral roles, and engaging wider societal actors. The revision should appropriately reflect post-2015 global health priorities while ensuring clarity for both current implementers and wider stakeholders.

XI. Universal Access and Health Equity:

• STAG-TB, through its Universal Access Task Force, recommended the establishment of universal access indicators where relevant, alongside more tailored country-specific strategies to enhance equity in TB service delivery.

XIII. Regional Office Coordination:

• STAG-TB stressed the critical function of regional and country-level offices in managing change, developing regional strategies, capacity building, and conducting comprehensive situation analyses to align national targets and address specific country needs.

XIV. Strategic Advisory Groups:

• STAG-TB recommended strengthening regional strategic technical advisory structures to ensure effective guidance and oversight with respect to the introduction and scale-up of new interventions.

XVI. Diabetes Mellitus/TB Collaboration:

• STAG-TB endorsed a structured framework for collaborative TB/diabetes programs, emphasizing the need for joint care pathways within strengthened health systems.

XX. TB and Women/Children's Health:

• STAG-TB advocated for integrating TB care within broader maternal and child health initiatives and emphasized pediatric TB research initiatives.