2003-06-25-世界卫生组织-Report_of_the_3rd_Meeting_of_the_Strategic_and_Technical_Advisory_Group_for_TB_18页_654kb

Summary of the Third Strategy and Technical Advisory Group for Tuberculosis (STAG-TB) Meeting (23-25 June 2003)

Core Content

The Third Strategy and Technical Advisory Group for Tuberculosis (STAG-TB) meeting was held at the World Health Organization (WHO) Headquarters in Geneva from 23 to 25 June 2003. The group, composed of 18 members representing diverse disciplines, aimed to provide scientific and technical guidance to WHO's Stop TB Department in areas such as public policy development, operational research, and research and development.

Main Objectives

The meeting had several key objectives:

• To present the progress of the five-year plans of action of WHO's regional offices.
• To review strategic directions for global DOTS (Directly Observed Treatment, Short-course) expansion towards the 2005 targets and beyond.
• To evaluate global case detection under DOTS and progress towards the 70% target.
• To inform on initiatives aimed at increasing case-finding.
• To present and discuss the report on human resource development for TB control in high-burden countries.
• To discuss and obtain approval for the global TB/HIV policy document.
• To present WHO's coordination of the global TB/HIV working group.
• To discuss the Cochrane Review on the effectiveness of DOT versus self-administered treatment.
• To review the results of the 2002 financial monitoring project and present the 2003 data collection form.

Key Recommendations

1. Regional/Global Responses to STAG 2002 Recommendations

• A joint presentation or paper should be prepared reviewing the tuberculosis research programme of WHO and TDR.
• WHO should present the results of the latest drug resistance surveillance surveys before their 2004 publication.

2. Common Issues in Regional Work Programmes

• Regional programmes should define comparative advantages and roles, and facilitate partnerships.
• Activities within work programmes should be prioritized based on needs, capacities, and comparative advantage.
• Pilot and scale-up of new strategies should be supported in collaboration with WHO/HQ.
• Steps to measure case detection and strategies to increase detection should be defined.

3. Regional Work Programmes

African Region

• Urgent prioritization of the work programme due to capacity constraints.
• Stimulation of high-level missions to foster political commitment for TB/HIV programmes.
• Focus on reducing high TB case-fatality rates in HIV/TB burden settings.

American Region

• Exploration of the relationship between HIV interventions and TB in Brazil.
• Increased political commitment in Brazil and Peru for TB control.

Eastern Mediterranean Region

• Continued efforts in epidemiological trend analysis and operational research.
• Increased focus on demand-side constraints and social mobilization.
• Examination of opportunities to build on the success of polio eradication campaigns.

European Region

• Proactive seeking of European bilateral and multilateral commitments.
• Ensuring accurate case detection rates using culture-positive TB as the denominator.
• Encouraging governments to improve notification of detected cases.

South-East Asia Region

• Further documentation of evidence for DOTS expansion.
• Facilitating efficient use and sustainability of resources.
• Addressing public-to-public collaboration for case detection and notification.
• Assisting countries in managing absorption capacity with new funding sources.

Western Pacific Region

• Continued improvements in public health infrastructure post-SARS.
• Support for research on TB control interventions.
• Collaboration with partners to examine human resource constraints.

4. Measuring Progress Towards 2005 Targets

• WHO should formally adopt the Millennium Development Goals (MDGs) as a framework for evaluating TB control implementation and impact.
• Clarify and document options for measuring progress in reducing TB incidence, prevalence, and mortality.
• Provide countries with guidance on analyzing routine and survey data.
• Adapt approaches to meet varying analytical needs across TB burden settings.

5. Initiatives to Improve TB Case-Finding

• WHO should support efforts to improve the evidence base on the effectiveness and cost-effectiveness of various case-finding initiatives.
• Develop a combined assessment of the status and applicability of these initiatives.
• Create cohesive packages for countries to prioritize and implement interventions.
• Promote public-public collaboration for enhanced reporting and referral.
• Document the impact of improving laboratory capacity on case detection.

6. Human Resources Development

• Foster a balance between policy development and on-ground implementation.
• Ensure defined TB HR plans and focal points within National Tuberculosis Programmes (NTPs).
• Compile a library of training materials to avoid duplication.
• Promote cross-national training and use of centres of excellence.
• Implement in-service coaching and supervision to address staff turnover.
• Integrate training efforts with other priority programmes.
• Document and share best practices from countries like India and Indonesia.
• Compare HR availability across different public health programmes.

7. TB/HIV Policy Guidelines

• Endorse the guidelines with minor language and categorization recommendations.
• Prioritize implementation of the guidelines in countries.
• Use the interim policy document as a basis for the World Health Assembly in 2004.
• Expand collaboration on joint policy development, country support, and resource mobilization.
• Intensify case-finding among HIV-positive individuals and HIV testing among TB patients.
• Assist in establishing national TB/HIV coordinating committees.
• Develop regional adaptations of guidelines.
• Support countries in scaling up joint TB/HIV activities.

8. Cochrane Review on DOT versus Self-Administered Treatment

• Support further studies on the effectiveness of DOT in treatment adherence and preventing drug resistance.
• Provide opportunities for open discussion on selected themes at future STAG meetings.

9. Financial Monitoring Report

• Continue reviewing data from the first round of financial monitoring and adapt tools accordingly.
• Ensure feedback to national counterparts and share results with STAG-TB.

Next Meeting

The fourth meeting of STAG-TB was scheduled for late June 2004.

Participants

• STAG-TB Members: Dr. Francis Adatu-Engwau, Dr. Martien Borgdorff, Professor Fadila Boulahbal, Dr. Jaap F. Broekmans (Chairman), Dr. Myrna Cabotaje (Vice Chair), Dra Mirtha Del Granado, Dr. Peter Godfrey-Faussett, Dr. Refiloe Matji, Dr. Anthony D. Harries, Dr. P.R. Narayanan, Ms. Teresa J. Ho, Dr. Rick O'Brien, Dr. C. Guerra de Macedo, Dr. Ariel Pablos-Mendez, Dr. Jaouad Mahjour, Dr. Sheela Rangan, Dr. Hans Rieder, Professor Peter M. Small.
• Co-opted Participants: Dr. Gijs Elzinga, Dr. Paul Garner, Ms. Christy Hanson, Dr. Bertie Squire, Dr. Ira David Rusen, Dr. Jimmy Volmink.