2001-07-06-世界卫生组织-Report_of_the_1st_Meeting_of_the_Strategic_and_Technical_Advisory_Group_for_TB_7页_284kb

Summary of the First STAG-TB Meeting (4-6 July 2001)

Background

The first Strategy and Technical Advisory Group for Tuberculosis (STAG-TB) meeting was held in Geneva on 4–6 July 2001 at the World Health Organization (WHO) headquarters. STAG-TB is composed of 18 members representing diverse disciplines, including public policy, operational research, and R&D. The group's mission is to provide scientific and technical guidance to WHO on global TB control efforts, ensuring the development of effective, adaptable, and cost-efficient strategies.

Objectives of the Meeting

The meeting aimed to address several key areas:

1. Briefing on global TB epidemiology and control targets: To discuss the current status of TB control and the challenges in achieving global targets by 2005 and 2010.
2. Revised framework for TB control: To review and refine the framework for TB control, including the use of DOTS (Directly Observed Treatment, Short-course).
3. New strategic framework for TB in HIV-prevalent populations: To develop and endorse a framework tailored for TB/HIV co-epidemic areas.
4. Revisions to WHO treatment guidelines: To identify and agree on key areas for updating the treatment guidelines.
5. Progress report on DOTS-Plus Initiative: To evaluate the status of the initiative targeting multidrug-resistant TB (MDR-TB).
6. Presentation of TB research strategy: To outline the current TB research strategy and the 2002–2003 workplan.

Key Recommendations

Objective 1: Global TB Situation and Targets

• STAG-TB emphasized the need for a revised assessment of case detection and cure rates, based on updated epidemiological data and DOTS expansion.
• Recommended national TB monitoring system evaluations and the use of rational methods for estimating TB prevalence and mortality.
• Highlighted the lack of global acceleration in DOTS coverage, with some exceptions like India.
• Endorsed the Stop TB surveillance and monitoring systems, supported a global fund monitoring mechanism, and encouraged national and global expansion plans.
• Advocated for human resource development, especially in high-incidence, resource-poor countries, and strategies for smaller countries with high TB/HIV burdens.

Objective 2: Revised Framework for TB Control

• Maintained the use of "DOTS" as the core strategy, but clarified it is not an acronym.
• Recommended involving communications experts to refine the terminology for advocacy.
• Supported the revised framework with 5 key elements and a list of key operations.
• Identified key areas for attention: scaling up DOTS, patient-centred care, adapting DOTS to local conditions, quality assurance, HIV-associated TB, MDR-TB, and stakeholder partnerships.
• Suggested additions to the framework including:
  • A preface and expanded introduction to explain the new orientation (public health, human rights, poverty/equity).
  • Human resource development and operational research as key operations.
  • Drug supply concepts such as quality assurance, bioavailable FDCs, GNP-certified suppliers, efficient procurement, and blister packs.
  • Financial analysis and monitoring and drug-resistance surveillance.
  • Explicit discussion of private providers.
  • Formation of a committee for final revisions.
  • Completion of the framework before the Stop TB Partners Forum in October 2001.
  • Publication in a peer-reviewed journal (e.g., IJTLD) after official WHO release.

Objective 3: Strategic Framework for TB in HIV-Prevalent Populations

• Endorsed a new strategic framework for TB/HIV co-epidemic areas with modifications.
• Recommended collaboration between STB and the HIV/AIDS Department.
• Urged speedy finalization, approval, and dissemination of the framework.
• Supported evidence-based technical guidance for implementation.
• Encouraged operational research to evaluate HAART treatment feasibility and cost-effectiveness.
• Advocated for improved financing sections with cost-effectiveness evidence.
• Highlighted the importance of intensified case-finding, infection control, and community involvement in TB/HIV interventions.

Objective 4: Revisions to WHO Treatment Guidelines

• STAG-TB endorsed the need to revise the treatment guidelines.
• Recommended establishing a small expert group to assist in the revision process.

Objective 5: DOTS-Plus Initiative Progress

• Noted progress in the DOTS-Plus Initiative and the launch of the Green Light Committee.
• Encouraged continued consultation and data-gathering to evaluate best practices in MDR-TB treatment.

Objective 6: TB Research Strategy and Workplan

• Supported TDR's new role in TB research, including resource mobilization and research prioritization.
• Endorsed the TB research framework encompassing basic science, applied research, tools development, and capacity building.
• Encouraged collaboration with STB on operational research, with TDR focusing on capacity building and STB on addressing priority problems.
• Recommended further consultation with regional and national TB programme managers and review of the operational research priority list from February 2000.

Priority Topics for STAG-TB 2002

1. Updates on operational strategy for TB among HIV-infected people
2. WHO TB research strategy
3. WHO response to health sector reform opportunities

Other Issues

• STAG-TB acknowledged the creation and restructuring of the STB department, the formal structuring of the Stop TB partnership, the development of working groups, and the launch of the Global Drug Facility (GDF).
• Noted ongoing social and political mobilization efforts.
• Dr. J. Broekmans was re-elected as Chair ad-interim of STAG-TB.
• Encouraged the inclusion of HIV/AIDS managers and additional social science experts in future meetings.
• Promised ongoing email-based communication with STAG-TB members during 2001–2002.

Members of STAG-TB

• Control and Country Operations:

  • Dr M. Mantala (Philippines)
  • Dr D. Enarson (IUATLD, France)
  • Dr R. Matji (South Africa)
  • Dr S.J. Kim (Republic of Korea)
  • Dr Francis Adatu-Engwau (Uganda)

• Health Systems, Services and Policy Research:

  • Dr C. Guerra de Macedo (Brazil)
  • Dr A. Harries (Malawi)
  • Dr J. Kim (Harvard Medical School, USA)
  • Dr S. Rengan (MSF, India)
  • Dr P. Hopewell (University of California, USA)

• Epidemiological and Basic Research:

  • Dr R. O'Brien (CDC, USA)
  • Dr M. Borgdorff (KNCV, Netherlands)
  • Dr P. Small (Stanford University, USA)
  • Dr P. Godfrey-Faussett (London School of Hygiene and Tropical Medicine, UK)
  • Dr P.R. Narayan (ICMR, India)
  • Dr A. Pablos-Mendez (Rockefeller Foundation, USA)

Total Members: 17