TB awareness campaign launched in Moldova

14 October 2009 – Balti, Moldova – This week the Moldovan NGO, Speranta Terrei, has kicked off a TB awareness campaign in this northern city of 128 000 residents. The campaign is built around the image and messages of Stop TB Partnership Ambassador Luis Figo and includes the launch of the comic book Luis Figo and the World Tuberculosis Cup.

In the run-up to the launch the group hung two large banners bearing Figo’s image along Avenue Stefan cel Mare. The display was made possible through the support of Mayor Vasili Panciuc and Vice Mayor Irina Serdiuc. The mayoralty also donated the use of an auditorium for the launch, which took place on 9 October.

At the launch event volunteers from Balti Medical College, who had formed a theatre troop for the occasion, re-enacted the battle between Figo’s team of teens and the team of TB germs that takes place in the comic book Luis Figo and the World Tuberculosis Cup. A public service announcement on TB, featuring Figo, was also screened for the audience in its Russian-language version. Mayor Vasilii Panciuc of Balti, Dr Feodora Rodiucova of Speranta Terrei, and Dr. Silviu Ciobanu of WHO’s country office opened the event with remarks on combating TB and using Figo comics to communicate with school children.

Igori Istratii, vice-captain of the football club “Locomotiv” in Balti, told the gathering about Luis Figo’s life and his football prowess. He said he will share Figo’s TB messages with his team members. Dr Rodiucova presented the story depicted in the comic book, which is being distributed to local school children this week along with materials from Moldova’s national TB public awareness campaign.

A segment on the event was broadcast on the evening television news on Balti Teleradio. In-depth reports on the campaign will be broadcast in the coming week on Republican (national) Television and Balti Teleradio.

The Figo campaign, which is supported by the Stop TB Partnership, is starting up in Balti’s schools and kindergartens but will fan out across the country. The team of volunteers also will deliver messages about tuberculosis and distribute comic books and postcards in the Moldovan cities of Chisinau, Orhei and Ungheni.

 

African TB Partners Call on African Heads of State, Health & Finance Ministers to Fund the Africa Gap in the Global Plan to Stop TB.

 

We participants at the 3rd Stop TB Partners Forum holding in Rio, Brazil from 23-25 March 2009 and other concerned organizations, institutions and persons.

 

Very concerned that 4.2 million Africans are currently living with TB and of these, 2.8 million are new TB cases – and the situation worsens with every passing day – as a person with active TB can infect 10 to 15 persons a year – making TB arguably Africa’s biggest public health concern.

 

Appalled that an estimated 639,089 African lives are lost to TB annually and the situation worsens daily.

 

Dismayed that despite African governments declaring TB as an emergency in 2005, Africa is the region with the largest funding gap (US$10.7 billion) for funding the fight against TB. i.e. the difference between total needs for full implementation of the Global Plan to Stop TB 2006-2015 and projections of the funding that will be available over the next 10 years. 

 

Consequently:

– Even though Africa makes up only 11.7% of the global population, Africa alone contributes 27 of the 50 countries globally with the highest prevalence of people living with TB, and also 26 of the 50 countries with the highest number of deaths globally.  This reflects the scale of Africa’s epidemic – and its potential to rapidly get worse.

 

– Furthermore, Nine of the world’s 22 TB high-burden countries are in Africa, i.e. Democratic Republic of Congo, Ethiopia, Kenya, Mozambique, Nigeria, South Africa, Uganda, United Republic of Tanzania and Zimbabwe.

 

– Outbreaks of Extensively drug-resistant tuberculosis (XDR TB) and Multidrug-resistant tuberculosis (MDR TB) now threaten to further complicate the TB epidemic in these and other countries.

 

– In the context of TB/HIV co-infection, TB being the biggest killer of HIV positive persons and the need for coordinated TB / HIV treatment  – 22 high HIV prevalence countries with an estimated adult HIV prevalence rate equal to or greater than 4% are in Africa: Botswana, Burundi, Cameroon, Central African Republic, Congo, Côte d’Ivoire, Democratic Republic of Congo, Ethiopia, Gabon, Kenya, Malawi, Mozambique, Namibia, Nigeria, Lesotho, Rwanda, South Africa, Swaziland, Uganda, United Republic of Tanzania, Zambia, Zimbabwe.

 

– In addition and very worryingly the AU African integration agenda could be undermined by the fact that five of the TB most affected countries; Nigeria, Ethiopia, South Africa, DRC and Kenya are all also amongst Africa’s most highly populated countries; are all regional hubs; or countries with the most number of common borders with other countries. 

 

Noting that Africa’s social and economic development could also be further undermined by a worsening of the TB epidemic as latest Stop TB partnership / World Bank analysis indicates that the economic cost of not treating TB to Africa between 2006 and 2015 would be $519bn while TB can be controlled with $20bn in the same period.

 

Hereby call on and appeal to African Heads of State, and Ministers of Health and Finance to urgently:

 

•           Accelerate efforts towards meeting the outstanding AU Abuja pledge to allocate 15% of national budgets to health as reiterated at the 2008 AU Summit in Egypt, the 2008 Conference of African Finance Ministers, and 2008 Special Conference of African Health Ministers.

 

•           Specifically work with the international community to ensure the mobilisation of African and other resources towards closing of Africa’s (US$10.7 billion) funding gap for implementation of the Global Plan to Stop TB, as the situation can only get worse if not urgently addressed.  

 

•           Initiate action on the call for a joint conference of African Health and Finance Ministers by 2010 to address details of how to mobilise and efficiently allocate more domestic African resources for actualisation of the AU Africa Health Strategy, all Health MDG’s, and rebuilding of health systems, including resolution of key factors such as health workforce shortages to urgently address Africa’s overall public health tragedy which currently claims over 8 million lives a year.

 

•           Ensure that the joint conference of African Health and Finance Ministers holds as a prerequisite to the Abuja + 10 review of the 2000/2001 AU Abuja Commitments and declarations on health development and financing.

 

We also Congratulate African Parliamentarians: 

 

•           On the formation of the Network of African Parliamentarians for Health Development and Financing and urge the Network as elected representatives of various constituencies to act speedily to ensure increased and efficient funding for health through parliamentary action to actualise the Abuja AU call for 15% of national budgets to be allocated to health. 

 

•           Urge the Network to ensure funding to fight TB by working towards ensuring the closing of Africa’s (US$10.7 billion) funding gap for implementation of the Global Plan to Stop TB.

 

•           And further urge the Network to accelerate national debate’s and action on the implementation of the AU Africa Health Strategy, health based MDG’s and rebuilding of health systems to ensure a sustainable basis for African social and economic development. 

 

Signatories in Alphabetical order:

 

·    Africa Internally Displaced Persons Voice (Africa IDP Voice)

·    Africa Public Health Alliance & 15% Campaign

·    Afrihealth Information Projects, Nigeria

·    Ambassadors of Change NGO, Kenya

·    Association of Women Living With HIV/AIDS in Nigeria (ASWHAN)

·    Centre for Health Systems Research & Development, University of the Free State, South Africa

·    Centre for Hospital and Health Services Improvement (CHAHSI Nig.)

·    Centre for Health, Science & Social Research (CHESSORE), ZAMBIA

·    Ghana Coalition of NGOs in Health 

·    HESI International Social Agency, West Africa

·    Health Workforce Advocacy Initiative (international)

·    Kenya AIDS NGOs Consortium (KANCO)

·    National Nurses Association of Kenya

·    Physicians for Human Rights (USA)

·    Positive-Generation, Cameroon

·    Positive Life Association of Nigeria (PLAN), Nigeria

·    Re-action Consulting, South Africa

·    Treatment Action Movement (TAM) – Nigeria

·    Uganda Association of Physiotherapy

·    Youth Intercommunity Network, Kenya

 

 

SIMPLISTIC AND REALISTIC WAY TO FIGHT TB, by Dr Jean Michel Kayumba

TB is a preventable and curable disease, which unfortunately still kill million and millions of people around the world action has been taken , speeches has been louder, conferences and forums has been held like the current on (3d forum STOP TB PARTNERSHIP ) which I strongly appreciate and encourage discussion has been held at all level but we seem to turn around the same point WHY?
 
 
Because the approach that I encourage is the simplistic and realistic approach to be adopted by all stakeholders in the fight against TB and we will certainly achieve the goal of stopping TB   and keep the world free of TB by 2050.
 
Articulate in few point points it’s a PERSON CENTRED APPROACH:
 If we don’t get a buy in from the patient and community(man) we will fail
 
1. Early detection of the disease is the key to  a successful treatment outcome and this involve the family, the community who must be trained and made aware of the early symptoms of the disease  for an early and prompt referral to the nearest hospital facility without a referral the nurse waiting  at the clinic will wait until the disease is advance to be treat and the spread of the disease will be so vast that it will be difficult to control use the BURKINA FASO  example with a strong community involvement in the referral system and the destigmtisation of the disease everyone care about everyone without stigma and judgement. Involve the other strong and until now neglected in the fight against TB the traditional healer in the channel of referral system. 
 
2. Proper and same standard diagnostics tools with well trained laboratory technician (Person)  to unable the early detection at the centre of reference, why same standard ? I acknowledge much effort has been put in place by the FIND to equipped developing country with innovative diagnostics tools that still not enough and that the aim of our fight is to get those tools accessible to the remote area of our villages in Africa in Asia and else where, as long as this tools are only accessible to the big city and the remote area are note benefiting we are heading to a failure. I am advocating for the accessibility by the person through training and reduce the distance between the lab and the people.
 
3. Access to available treatment is a real problem and that is also a person centred problem , I worked in remote rural area as doctor other colleagues who have worked in remote area will agree with me that the very remote area are victim of the break in the channel of medicine supply and several interruption and delay in the delivery of medication leaving the doctors and nurses helpless while waiting for the next package to reach the village  in two to three weeks  as we all  know this will lead to development of resistance strains  is good to always incriminate the patient as a defaulter but in this cases despite the willingness of the  patient to take treatment the NTP has fail the patient .
 
4. Reinforce an other person centred method the DOT strategy by strong community involvement (FBO,NGO,…
 
4. Poverty and high unemployment rate is certainly an cause of the failure of the system , poor adherence to the treatment is result from the fact the patient is poor enough that he can not secure a proper meal in order to take medication , this lead to a high default rate  impacting to  a treatment outcome and lead to the development of more resistance strain, attending realistically to simplistically to this matter will lead to a better treatment outcome.
 
5.Patient support throughout the course of the regimen with the active involvement of the community will be helpful.
 
6. Infection control through simple means such as cough or respiratory hygiene ,open widow, personal protection… should be encouraged instead of spending millions on sophisticated UV light which will reach only small community in big cities.
 
They all other point that I would like to raise about the simplistic and realistic approach in the fight against TB, all part of an operational research study to be publish soon with data and experiences on the ground.

 

Declaração Comunitária do Rio

Nós, membros da sociedade civil e, em especial as pessoas infectadas e afetadas pela TB, assim como aquelas engajadas na luta contra esta doença, publicamos esta Declaração para chamar a atenção para os seguintes fatos:

• embora seja curável, a TB mata anualmente quase dois milhões de pessoas no mundo inteiro. A maioria dos programas de TB espera que a pessoa com tuberculose venha até a clínica ser examinado para a doença. Este método passivo de busca de casos atrasa o diagnóstico e permite à TB se disseminar na comunidade. A ferramenta de diagnóstico mais largamente utilizada, o exame de escarro (esputo) direto, detecta apenas 45-65% dos casos de TB, de modo que, mesmo quando os pacientes são submetidos aos testes de TB, é possível que eles não recebam um diagnóstico preciso ou rápido. Este método não é eficiente na detecção da TB ativa em pacientes com tuberculose extra-pulmonar, naqueles co-infectados com o HIV (com micobactérias insuficientes ou inexistentes no escarro), e seu uso é limitado na detecção da TB entre crianças, algumas das comunidades sob grande risco de morte devida à TB.
• A TBMR/XR está aumentando e recebendo respostas inadequadas ou inapropriadas. O diagnóstico da tuberculose resistente a drogas múltiplas (TBMR ou MDR em inglês) e da TB extensivamente resistente a drogas (TBXR ou XDR) requer tecnologias até mais sofisticadas do que a TB comum. A espera demorada pelos resultados dos testes é uma grande preocupação e afeta diretamente a mortalidade (especialmente entre pacientes co-infectados com HIV) e a qualidade do tratamento que é oferecido. As drogas de segunda linha utilizadas contra a tuberculose resistente a drogas múltiplas e a extensivamente resistente a drogas devem ser tomadas por um longo período, são altamente tóxicas e podem causar diversos efeitos colaterais graves, inclusive hepatite, depressão, alucinações e tonteiras. Em 2007, menos de 1% dos casos estimados de TBMR foram tratados de acordo com as diretrizes da OMS, utilizando as ferramentas de diagnóstico e as drogas disponíveis para o tratamento da TB MDR/XDR.
• A hospitalização obrigatória e o tratamento sob internação da TB sobrecarregam ainda mais o sistema de saúde e não é necessariamente o tratamento mais efetivo para a TB, e muito menos para a TBMR. Programas de agentes comunitários de saúde em diversos países evidenciaram melhores resultados de tratamento, são econômicos e facilitam o acesso a serviços fundamentais. Apesar desta evidência, pouquíssimos programas nacionais de TB adotaram os modelos como norma para o tratamento da TB e da TBMR.

 

 

 

 

 

• As respostas à co-infecção de TB/HIV continuam demasiado fracas. Embora a TB continue a ser a principal causa de morte entre as pessoas com HIV e aids, as diretrizes da OMS para a colaboração/integração dos serviços de TB e HIV-DST/aids não têm sido implementadas consistentemente, especialmente as que objetivam reduzir a carga de TB entre as pessoas infectadas com HIV:
  • nos últimos 15 anos, novos casos de TB mais do que triplicaram em países com elevadas prevalências de HIV. Em um determinado ano, as pessoas que vivem com HIV/aids tem probabilidade 50 vezes maior de desenvolver a TB ativa, comparadas aos indivíduos HIV-negativos.
  • embora os testes e exames para TB possam detectar com rapidez e economia o risco de TB entre pessoas com HIV, consta que apenas 630.000 pessoas (cerca de 2%) dentre as que vivem com o HIV foram examinadas para a TB em 2007.
  • apesar da evidência de que a terapia preventiva com a isoniazida (TPI) possa reduzir em 60 a 80% a incidência de TB entre as pessoas com o HIV, apenas 0,1% das pessoas qualificadas a recorrer à IPT receberam esta terapia salvadora.
  • alguns medicamentos utilizados contra a TB interagem com o tratamento anti-HIV, acarretando efeitos colaterais graves nos pacientes co-infectados com o HIV, que precisam ser adequadamente monitorados e supervisionados.
  • embora as condições dos serviços de saúde representem um risco redobrado de transmissão da TB aos seus funcionários, poucas instalações na área de saúde implementaram medidas simples de controle de infecção para proteger os funcionários de saúde e os pacientes.

 

 

Os recursos financeiros e os compromissos continuam insuficientes. Dados mais recentes disponíveis sobre os recursos que são alocados para os programas de combate à tuberculose (US$ 3 bilhões, em 2009) e pesquisa (US$ 483 milhões, em 2007) são absolutamente insuficientes, se comparados aos US$ 5 bilhões necessários aos programas, em 2009, e os US$ 2 bilhões para a pesquisa, em 2007. De acordo com os níveis atuais de financiamento, as metas estabelecidas pelo Plano Global de Combate à TB (2006-2015) não serão cumpridas até 2015. É necessário que os doadores internacionais e os governos nacionais invistam em novos diagnósticos e tratamentos, que comecem a lidar com o sofrimento e com a ameaça crescente da TB.

• São poucas as respostas com base em direitos, enquanto que as necessidades dos mais marginalizados continuam a ser ignoradas. Embora o respeito pelos direitos humanos e a promoção de saúde pública sejam mais eficientes quando atuam conjuntamente, os programas de combate à TB e, especialmente à TBMR, não têm se esforçado por obter um equilíbrio ideal entre os dois. Além disso, serviços e assistência acessíveis e de qualidade aos mais vulneráveis e marginalizados socialmente, inclusive privados da liberdade, usuários de drogas, refugiados e trabalhadores migrantes, não são disponibilizados ou são extremamente limitados.

 

• Continua fraca a participação efetiva da sociedade civil no desenvolvimento e na implementação de políticas e de programas. As contribuições e perspectivas da sociedade civil quanto à TB continuam relativamente ausentes da maior parte da defesa de interesses em recursos, políticas, programas e tomada de decisões, especialmente no nível do país.

 

Em vista da situação atual, recomendamos aos governos, doadores e influenciadores de políticas globais, pesquisadores e ativistas simpatizantes da sociedade civil que:

• ajam com sentido de urgência e se aliem com diferentes parceiros para criar e implementar planos nacionais coerentes que contenham metas claras, para exibir uma resposta consistente à TB;
• invistam os US$ 44 bilhões necessários ao controle da TB entre 2009 e 2015, cumprindo na íntegra a promessa do Plano Global, e pelo menos mais US$ 2 bilhões anuais para a pesquisa em TB, urgente e não abordada pelo plano.
• tornem o tratamento comunitário, o apoio de agentes comunitários de saúde, inclusive para a TBMR, assim como a busca ativa de casos de TB, componentes fundamentais para uma resposta efetiva à TB.

 

Embora todos nós devamos nos envolver no combate à TB, também acreditamos que diferentes instituições e parceiros tenham responsabilidades específicas. Neste sentido, insistimos para que os governos, doadores, agências financiadoras, programas nacionais, pesquisadores, agências, entidades e programas internacionais (OMS, a Stop TB Partnership e o UNAIDS, respectivamente), assim como organizações e entidades de comunidades de pessoas infectadas/afetadas pela TB, dêem atenção urgente às seguintes áreas:

 

 

Desenvolvimento e implementação de políticas e programas

• Os governos deverão garantir que a abordagem “centrada no paciente”, que respeite os direitos humanos, seja o princípio orientador básico em todos os esforços de assistência à TB.
• Os profissionais da área de saúde, prestadores de serviços e as organizações da sociedade civil deverão garantir que os princípios dispostos no Estatuto do Paciente para o Tratamento da Tuberculose sejam respeitados, a fim de reduzir o estigma e combater a discriminação.
• Os programas nacionais de combate à TB deverão implementar o algoritmo da OMS para diagnosticar a TB extra-pulmonar e em exames negativos de escarro, assim como expandir o acesso a testes de culturas e sensibilidade às drogas.
• Os programas nacionais de combate à TB deverão estabelecer parcerias com organizações da sociedade civil para determinar ativamente os casos de TB na comunidade, evitando a sua transmissão e as mortes devidas a falhas no seu diagnóstico.
• Os programas nacionais de combate à TB e às (DST) HIV/aids deverão colaborar para que, até 2010, se obtenha o acesso universal a serviços em TB/HIV, em consonância com o Plano Global e com as metas do UNAIDS.
• Os programas nacionais de combate à aids deverão assumir a sua responsabilidade, garantindo que cada pessoa com HIV seja regularmente examinada para a TB e receba tratamento e/ou prevenção, conforme o caso, e que cada clínica de aids adote medidas de controle da infecção para reduzir a transmissão de TB.
• A Stop TB Partnership e a OMS deverão assumir uma liderança mais proeminente para catalisar recursos, assim como fornecer orientação aos países quanto às políticas e suporte técnico para lidar com os desafios no controle da TB, inclusive infraestrutura laboratorial, DOTS comunitária, co-infecção de TB/HIV e TBMR.
• Os programas nacionais de combate à TB deverão adotar a recomendação do Conselho do Fundo Global que insta os países a encaminhar propostas para expansão da capacidade laboratorial e da gestão comunitária dos casos de TBMR/XR.
• Os programas nacionais de combate à TB e à HIV/aids deverão adotar a recomendação do Conselho do Fundo Global, incluindo e implementando intervenções de combate à TB contundentes e significativas nas propostas vinculadas a HIV/AIDS e intervenções de combate ao HIV/AIDS nas propostas vinculadas à TB.
• Os doadores deverão fornecer imediatamente novas garantias para suprir a lacuna de US$ 5 bilhões no Fundo Global para a AIDS, TB e Malária, o maior financiador externo em TB, e para garantir a realização da prometida expansão dos programas.
• Os doadores deverão colaborar com a Organização Mundial de Saúde (OMS) e com a Stop TB Partnership para harmonizar os seus indicadores, monitoramento e estruturas de avaliação, visando reduzir a carga sobre os recebedores de financiamentos.

 

Pesquisa e novas ferramentas de diagnóstico

• Os pesquisadores deverão desenvolver parcerias buscando resultados imediatos, para garantir o melhor uso das ferramentas disponíveis, e para desenvolver e defender os direitos de financiamento para uma pauta abrangente de pesquisas que leve em consideração as necessidades específicas de pacientes pediátricos de TB, pacientes co-infectados com o HIV e outras co-morbidades comuns, como a hepatite C. São urgentemente necessárias drogas menos tóxicas e mais potentes para abreviar a duração do tratamento e lidar com a TBMR.
• Os pesquisadores deverão priorizar o desenvolvimento de novas ferramentas diagnósticas que possam proporcionar um diagnóstico mais rápido e preciso da TB em casos de baciloscopias positivas, de baciloscopias negativas e de TBMR, inclusive diagnósticos apropriados às crianças, pacientes co-infectados com o HIV e para utilização em condições de poucos recursos. Existe uma necessidade extrema de novas ferramentas diagnósticas que sejam simples, confiáveis e adaptáveis às condições locais.
• Os pesquisadores, financiadores e os programas nacionais de combate à TB deverão trabalhar em conjunto para reforçar a infraestrutura de pesquisa nos países com elevadas cargas de TB, garantindo a capacidade adequada de conduzir pesquisas para desenvolver novas ferramentas e aprender sobre as melhores estratégias de implementação das ferramentas existentes.
• Os gestores e financiadores deverão garantir que as novas ferramentas diagnósticas e drogas desenvolvidas sejam disponibilizadas e acessíveis nos países mais necessitados.

 

Participação da sociedade civil

• As agências das Nações Unidas, doadores e governos deverão encorajar e apoiar a participação da sociedade civil em fórums nacionais e internacionais, e promover membros capacitados das comunidades como atores-chave e defensores de uma efetiva resposta contra a tuberculose. Este apoio precisará incluir capacitação e financiamento dos membros da sociedade civil, de modo que eles participem plenamente das decisões e logrem a devida representação de suas comunidades na definição das providências a serem tomadas para a resposta ao combate à TB.
• As pessoas com HIV e outras comunidades que forem particularmente afetadas pela TB deverão se informar sobre os seus direitos e responsabilidades, conforme a descrição que consta do Estatuto do Paciente para o Tratamento da Tuberculose, e aprimorar o nosso conhecimento sobre a ciência, pesquisa e políticas, para que possamos participar plenamente do programa de TB e da formulação de políticas de controle.
• Os programas nacionais de combate à TB deverão delinear com clareza o papel da sociedade civil nos esforços para o controle da TB em seus planos nacionais.
• Os pesquisadores deverão aglutinar o conhecimento e o poder de ativismo das comunidades, especialmente sobre a pesquisa que está sendo realizada, para defender os interesses em recursos para a pesquisa, e transformar as descobertas em programas e políticas palpáveis.
• A sociedade civil deverá desempenhar um papel fundamental para representar os interesses das pessoas afetadas na mobilização de recursos, com o propósito de atingir as metas do Plano Global e do Fundo Global, que foram fundamentais para fornecer recursos para o controle da TB em países com elevada carga de TB.

 

CHAMADA COMUNITÁRIA À AÇÃO PARA O CONTROLE GLOBAL DA TUBERCULOSE E ASSISTÊNCIA AO PACIENTE

REUNIÃO MINISTERIAL DE PAÍSES COM ELEVADA PREVALÊNCIA DE TBMR/XR, PEQUIM, CHINA 1-3 ABRIL 2009

 

A tuberculose resistente a drogas múltiplas (TBMR) e extensivamente resistente a drogas (TBXR) ameaça reverter as conquistas feitas pelos programas de TB e aids. Os altos níveis de mortalidade entre as pessoas com HIV devido à TBMR/XR exigem atenção especial, para que se evite e se trate devidamente a tuberculose resistente a drogas na população. O controle da infecção e a detecção precoce de casos deverão ser implementados para evitar e detectar a TB entre as pessoas com o HIV. Deve-se priorizar o apoio ao tratamento, para encorajar a sua conclusão.

 

Os participantes da sociedade civil presentes no 3º Fórum de Parceiros para o Combate à TB no Rio de Janeiro recomendam aos participantes desta reunião incluir os seguintes itens nos planos de ação desenvolvidos nos níveis de grupo e país:

 

• garantir que os testes diagnósticos e tratamentos necessários para a TB resistente a drogas sejam acessíveis sempre que se detectarem casos da TBMR/XR. Apoiar o desenvolvimento e a garantia de acesso a novas ferramentas diagnósticas que possam ser utilizadas no local de tratamento, e regimes de tratamento comprovadamente efetivos em crianças, e compatíveis com os medicamentos para o HIV.
• investir, entre 2009 e 2015, pelo menos os US$ 270 milhões anuais necessários para expandir a capacidade laboratorial, proporcionando acesso universal a testes de cultura e suscetibilidade a drogas, e desenvolvendo indicadores laboratoriais nacionais e regionais para medir o progresso.
• tornar econômico o cuidado comunitário da TBMR, que, de acordo com evidências, leva a melhores resultados de tratamento, e facilitar o acesso a serviços críticos, uma norma nos seus programas nacionais de combate à TBMR.
• a hospitalização obrigatória não deverá continuar a ser a resposta primária no tratamento da TB MDR, já que ela sobrecarrega ainda mais o sistema de saúde, viola os direitos dos pacientes e não garante o tratamento adequado e de qualidade, ou o seu sucesso.
• garantir que todos os pacientes de TB, inclusive os mais marginalizados na sociedade, possam receber um tratamento que garanta o seu êxito e respeite os seus direitos humanos.

 

 

 

 

 

La Declaración Comunitaria de Ríoen el Tercer Foro de Socios del Programa Alto a la Tuberculosis

 

Nosotros, los miembros de la sociedad civil, particularmente las personas con la infección y aquellas afectadas por la Tuberculosis (TB) y comprometidas en el combate a esta enfermedad, emitimos esta Declaración para hacer un llamado urgente a la atención al hecho de que:

 

·                         A pesar de que la TB es curable, cada año, ésta enfermedad mata cerca de dos millones de personas mundialmente. La mayoría de los programas de TB esperan a que la persona se enferme para que vaya a la clínica para ser examinada para la TB. Este método de búsqueda pasiva de casos ocasiona retraso del diagnóstico y permite que la TB se disemine en la comunidad. El método de diagnóstico comúnmente usado, la prueba de la baciloscopia, sólo permite la detección del 45 al 65 por ciento de los casos, así que aún cuando las personas se someten al examen para la TB, no reciben un adecuado y pronto diagnóstico. Este método es ineficiente para detectar TB activa en personas con TB extra-pulmonar, personas con coinfección con VIH (porque el micobacterium es insuficiente o no está presente en su flema) y su limitado uso en el diagnóstico en niños, y es por ello que estas comunidades están en un gran riesgo de morir de TB.

 

·                         La TB M/XDR (tuberculosis multi y extra-resistente)  está creciendo y está recibiendo una respuesta inadecuada e inapropiada.  El diagnóstico de la TB multi y extra-resistente requiere de una tecnología más sofisticada que la TB ordinaria. La prolongada espera de los resultados del diagnóstico es de gran preocupación y tienen un impacto directo en la mortalidad (especialmente en personas con coinfección por  TB/VIH) y en la calidad de los tratamientos que son ofrecidos. Los medicamentos de segunda línea usados para la Tuberculosis M/XDR deben ser tomados por largos periodos de tiempo, son altamente tóxicos, y pueden causar un amplio rango de serios efectos secundarios incluyendo hepatitis, depresión, alucinaciones  y vértigos. En el 2007, menos del 1% de los casos estimados de MDR fueron tratados de acuerdo a los lineamientos de la Organización Mundial de la Salud (OMS), usando las técnicas de diagnóstico y medicamentos disponibles para tratar la TB M/XDR.

 

·                         Hospitalización obligatoria y las clínicas de tratamiento de la TB sobrecargan un ya relajado sistema de salud y no es necesariamente la más efectiva atención para la TB y la TB MDR. En algunos países del mundo, los modelos de atención que se basan en la comunidad han demostrado que conducen a mejores resultados de tratamiento, son costo-efectivos, y facilitan el acceso a servicios críticos. A pesar de la evidencia, pocos Programas Nacionales de TB han tomado estos modelos como norma en la atención de la TB y de la TB MDR.

 

·               Las respuestas a la coinfección TB/VIH permanecen muy débiles. Aunque la TB continua siendo la principal causa de muerte entre personas con VIH/SIDA, las políticas de la OMS sobre los servicios de colaboración de TB/VIH no han sido consistentemente implementados, particularmente aquellos dirigidos a reducir el impacto de la TB en las personas con VIH/SIDA:

 

·                                         En los pasados 15 años, nuevos casos de TB se han triplicado en países con prevalencias altas de VIH. Las personas con VIH/SIDA son 50 veces más propensas a desarrollar TB activa en un año comparado con personas VIH negativas.

 

·                                         Mientras que el examen de la TB puede detectar el riesgo de la TB en personas con VIH de manera rápida y costo-efectiva, de sólo 630,000, se informó que el 2% de las personas con VIH fueron examinadas para la TB en 2007.

 

·                                         A pesar de la evidencia de que el terapia de prevención con Isoniazida (TPI) puede reducir entre un 60-80% la incidencia de la TB en personas con VIH, sólo el 0.1% de aquellas personas con VIH elegibles para la TPI han recibido esta terapia que les puede salvar la vida.

 

·                                         Algunos medicamentos para la TB interactúan con el tratamiento para el VIH, creando serios efectos secundarios para personas con coinfección con VIH, que necesitan ser adecuadamente tratados y monitoreados.

   

·                                         Aún sabiendo que los establecimientos de atención en salud poseen un doble riesgo de transmisión de la TB a sus trabajadores, algunos establecimientos de salud han implementado medidas simples para el control de la infección para proteger a los y las trabajadores(as) de atención de la salud y los y las usuarios(as) de dichos establecimientos.

 

·               Los recursos financieros y los compromisos permanecen insuficientes.  La información disponible más reciente sobre recursos destinados para los programas de TB ($3 mil millones en el 2009) e investigación ($483 millones de dólares en el 2007) son absolutamente insuficientes, comparados con los $5 mil millones de dólares que se necesitan para los programas en el 2009 y los $2 mil millones para investigación en el 2007. Con estos niveles de financiamiento, las metas establecidas en el Plan Mundial Alto a la TB (2006-2012) no serán alcanzadas para el año 2015. Los donantes internacionales y los gobiernos nacionales debe invertir en nuevos diagnósticos y tratamientos para empezar a atender el sufrimiento de cada persona y enfrentar la amenaza de la TB.

 

·               Las respuestas que se basan en los derechos y las necesidades de los más marginados continúan siendo insatisfechas.  Aunque el respeto de los derechos humanos y la promoción de la salud pública son más efectivos cuando operan conjuntamente, a menudo los programas de TB, especialmente los programas de MDR no han buscado un óptimo balance entre los dos. En adición, la atención y los servicios accesibles y de calidad para los más vulnerables y socialmente marginalizados, incluyendo las personas privadas de su libertad, usuarios de drogas intravenosas, refugiados, y trabajadores migrantes no son disponibles o son extremadamente limitados.

 

·               La significativa participación de la sociedad civil en el desarrollo de políticas y programas permanece débil. Las contribuciones y perspectivas de la sociedad civil en TB permanece relativamente ausente de la promoción y defensa de los recursos, la política y los programas y en la toma de decisiones, especialmente en el nivel de los países.

A la luz del estado actual de los asuntos, insistimos a los gobiernos, donantes y tomadores de decisión en todo el mundo, así como a los investigadores y compañeros activistas de la sociedad civil para que:

 

·                         Actúen con sentido de urgencia y colaboren con diferentes personas clave para concebir e implementar planes nacionales coherentes, con metas para ofrecer una respuesta integral a la TB;

 

·                         Inviertan los $44 mil millones de dólares para el control de la TB entre 2009 y 2015 para realizar completamente la promesa del Plan Mundial, y por lo menos los $2 mil millones de dólares adicionales para investigación de la TB, que son críticos y actualmente no considerados en el Plan;

 

·                         Hacer del tratamiento y apoyo comunitario, incluyendo la TB MDR, y búsqueda de casos activos de TB, componentes claves de una efectiva respuesta a la TB.

 

Considerando que todos debemos desempeñar nuestra parte en el combate a la TB, también creemos que las diferentes instituciones y actores clave tienen responsabilidades específicas. Desde ésta perspectiva hacemos un llamado a los gobiernos, donantes, agencias financiadoras, programas nacionales, investigadores, cuerpos internacionales (OMS, ONUSIDA y el Programa de Colaboración Alto a la TB) y comunidades de personas con TB y aquellas afectadas indirectamente por esta enfermedad para responder urgentemente a las siguientes áreas:

Política, Desarrollo de Programas e Implementación

·                         Los gobiernos garantizarán que un enfoque “centrado en la persona”, que respete los derechos humanos, sea un principio central que oriente todos los esfuerzos de la atención de la TB.

·                         El personal de atención de la salud, proveedores de servicios de salud y organizaciones de la sociedad civil aseguren que los principios subrayados en La Cartilla de los Pacientes para la Atención de la Salud sean apoyados para reducir el estigma y combatir la discriminación.

·                         Los Programas Nacionales de TB implementen los algoritmos de la OMS para diagnosticar la TB extra-pulmonar con baciloscopía negativa así como se amplíe el acceso al cultivo y examen de susceptibilidad de medicamentos.

 

·                         Los Programas Nacionales de TB colaboren con organizaciones de la sociedad civil para una búsqueda activa de casos de TB en la comunidad, para prevenir la transmisión de la TB y las muertes por TB no diagnosticada.

 

·                         Los Programas Nacionales de TB y de SIDA colaboren para lograr el Acceso Universal de los servicios de TB/VIH para 2010 de acuerdo al Plan Mundial y las metas del ONUSIDA.

 

·                         Los Programas Nacionales de SIDA asuman su responsabilidad de asegurar que cada persona con VIH regularmente sea examinada para la TB y se le ofrezca el tratamiento y/o la prevención adecuada, y que cada clínica de SIDA emplee medidas de control de la infección para reducir la transmisión de la TB.

 

·                         El Programa de Colaboración Alto a la TB y la OMS asuman un liderazgo más grande en su desempeño como catalizadores de recursos así como ofrecer a los países orientación en política y apoyo técnico para responder a los retos para el control de la TB que incluya infraestructuras de laboratorio, TAES que se base en la comunidad, coinfección TB/VIH y TB MDR.

 

·                         Los Programas Nacionales de TB deben seguir el llamado de la Junta del Fondo Mundial insistiendo en que los países envíen propuestas para ampliar la capacidad de laboratorio y manejo basado en la comunidad para los casos de TB M/XDR.

 

·                         Los Programas Nacionales de la TB deben seguir el llamado de la Junta del Fondo Mundial para incluir e implementar sustantivas y robustas intervenciones de TB en las propuestas de VIH/SIDA y de intervenciones de VIH/SIDA en las propuestas de TB.

 

·                         Los donantes inmediatamente ofrezcan nuevas promesas para cubrir la brecha de los $5 mil millones de dólares en el Fondo Mundial para el SIDA, la TB y la Malaria – el más grande financiador de TB- y asegurar que la promesa de ampliar los programas sea realizada.

 

·                         Los donantes trabajen con la Organización Mundial de la Salud (OMS) y el Programa de Colaboración Alto a la TB para que armonicen sus indicadores, monitoreen y evalúen su marco conceptual para reducir el impacto en los recipientes de sus fondos.

 

Investigación y Nuevas Herramientas

·                         Investigadores trabajen de manera colaborativa y con sentido de inmediatez para establecer el mayor uso de las herramientas actualmente disponibles y desarrollar y defender el financiamiento para una agenda de investigación integral que tome en cuenta las necesidades específicas de la TB pediátrica, las personas coinfectadas con VIH y otras co-morbilidades comunes como hepatitis C. Son urgentemente necesarios, menos medicamentos tóxicos y más potentes fármacos para reducir la duración del tratamiento y responder a la fármaco-resistencia.

 

·                         Los investigadores prioricen el desarrollo de nuevas herramientas de diagnóstico que puedan ofrecer un más rápido y adecuado diagnóstico de la baciloscopía positiva, baciloscopía negativa y fármaco resistencia a la TB, incluyendo un adecuado diagnóstico en niños y niñas, personas con coinfección con VIH y para su uso en lugares de escasos recursos. Hay una desesperada necesidad de nuevas herramientas para el diagnóstico que sean sencillas, confiables y que se adapten al campo.

 

·                         Investigadores, agencias financiadoras y Programas Nacionales de TB (PNT) trabajen conjuntamente para fortalecer la infraestructura de investigación en países con altas cargas de TB para asegurar que haya una adecuada capacidad para conducir investigación para desarrollar nuevas herramientas, así como aprender acerca de mejores estrategias para implementar las herramientas existentes.

 

·                         Implementadores y financiadores asegurarán que las nuevas herramientas para el diagnóstico y los nuevos medicamentos que sean desarrollados se hagan disponibles y accesibles en los países con mayor necesidad.

 

Participación de la Sociedad Civil

·                         Las agencias de la ONU, donantes y gobiernos alienten y apoyen la participación de la sociedad civil en los foros nacionales e internacionales y promuevan que los miembros de la comunidad capacitados sean implementadores activos y promotores de la respuesta. Este apoyo necesita considerar capacitación y financiamiento para los miembros de la sociedad civil de tal forma que ellos puedan participar plenamente en la toma de decisiones y buscar una contribución comunitaria más amplia en el establecimiento de la agenda para la respuesta de la TB.

 

·                         Las personas con VIH y otras comunidades que están desproporcionalmente impactadas por la TB aprendan de nuestros derechos y responsabilidades como se describen en La Cartilla de los Pacientes para la Atención de la TB, y eduquen sobre ciencia, investigación y política para que podamos participar plenamente en la formulación de políticas y programas de TB.

 

·                         Los Programas Nacionales de TB subrayen con claridad el papel de la sociedad civil en los esfuerzos para el control de la TB en los Programas Nacionales.

 

·                         Los investigadores aprovechen el conocimiento y poder del activismo de las comunidades, especialmente en quienes la investigación es conducida, para abogar por recursos para la investigación y la traducción de hallazgos de investigación dentro de sólidos programas y políticas.

 

·                         La sociedad civil desempeña un papel crítico en abogar para la movilización de recursos para responder a las metas del Plan Mundial y del Fondo Mundial que han sido críticos en ofrecer recursos para el control de la TB en países con altas cargas de TB.

 

 

LLAMADO COMUNITARIO PARA LA ACCIÓN DE LA

REUNIÓN MINISTERIAL DE LOS PAÍSES CON ALTAS CARGAS DE TB M/XDR PARA

EL CONTROL MUNDIAL DE LA TUBERCULOSIS Y LA ATENCIÓN DE LA PERSONA CON TB

BEIJING, CHINA (ABRIL 1-3, 2009)

La TB Multi Fármaco-Resistente (MDR) y la TB Fármaco Resistencia-Extendida (XDR) amenazan revertir los logros alcanzados por los Programas de TB y de SIDA. El más alto nivel de mortalidad entre personas con VIH debido a la TB M/XDR necesita una especial atención para prevenir y tratar la TB fármaco-Resistencia entre ésta población.  El control de la infección y temprana detección debe ser implementada para prevenir y detectar la TB entre personas con VIH y el apoyo al tratamiento debe ser priorizado para alentar que se complete el tratamiento.

Los y las participantes de la sociedad civil en el 3er. Foro de Socios del Programa Alto a la TB en Río de Janeiro, hacen un llamado a los participantes de esta reunión para incluir lo siguiente en los planes de acción que ellos desarrollen como grupo y como países:

·                         Asegurar que las necesarias pruebas para el diagnóstico y tratamientos para la TB fármaco-resistente sea accesible en los lugares en que se encuentre TB M/XDR. Apoyar el desarrollo y asegurar el acceso a nuevos instrumentos de detección que puedan ser usados en los puntos de atención, y que los regímenes de tratamientos haya probado sus efectividad en niños y niñas, y sean compatibles con los medicamentos para VIH.

·                         Invertir por los menos $270 millones que se necesitan cada año entre 2009-2015 para ampliar la capacidad de laboratorio para ofrecer Acceso Universal al cultivo y examen susceptibilidad de los fármacos y desarrollar indicadores de laboratorio nacionales  y regionales para medir el progreso.

·                         Poner en marcha atención con base en la comunidad para TB MDR, que ha demostrado conducir a mejores resultados de tratamiento, ser costo-efectivos, y facilitar el acceso a servicios críticos, como una norma en sus programas nacionales de TB MDR.

·                         La hospitalización obligatoria no debe ser la respuesta primaria al tratamiento para la TB MDR, considerando una sobrecarga a los ya agobiados sistemas de salud; infringe los derechos de las personas con TB y no garantiza una adecuada atención con calidad y ni siquiera asegura el éxito del tratamiento.

·                         Asegurar que todas las personas con TB, incluyendo a los más marginalizados en la sociedad, puedan recibir el tratamiento que respete sus derechos humanos y aseguren el éxito de su tratamiento.

 

 

 

03/02/2009           Traducción al español efectuada por Francisco Rosas (México)

                                Documento revisado por Francisco Carrillo (El Salvador), Ezio Távora dos Santos Filho (Brasil)

 

 

Rio Communities’ Declaration

We, members of civil society, particularly people who are infected and affected by and engaged in the fight against TB, issue this Declaration to call urgent attention to the fact that:

• Despite being curable, each year TB kills nearly two million people worldwide.  Most TB programs wait for the sick patient to come to the clinic to be screened for TB.  This method of passive case finding causes delays in diagnoses and allows TB to be spread in the community.  The most commonly used diagnostic tool, the sputum smear test, only allows the detection of 45-65 percent of TB cases, so that even when patients undergo TB testing, they may not receive an accurate nor prompt diagnosis. This method is ineffective to detect active TB in patients with extra-pulmonary TB, patients co-infected with HIV (who have insufficient or no mycobacterium in their sputum) and of limited use in detecting TB in children, communities at great risk of death due to TB. 
• M/XDR TB is on the rise and receiving inadequate or inappropriate responses.  Diagnosis of Multi and Extensively Drug Resistant (M and XDR) TB requires even more sophisticated technology than ordinary TB. The lengthy wait for test results are of great concern and have a direct impact on mortality (especially in TB/HIV co-infected patients) and the quality of the treatment that is offered. Second-line drugs used against M/XDR tuberculosis must be taken for long period of time, are highly toxic, and can cause a range of serious side effects including hepatitis, depression hallucinations and dizziness. In 2007, less than 1% of the estimated MDR cases were treated according to WHO guidelines using the diagnostic tools and drugs available to treat M/XDR-TB.
• Mandatory hospitalization and clinic based TB treatment overburdens an already stretched health system and is not necessarily the most effective care for TB and even MDR-TB.  Community-based models of care in several countries around the world have demonstrated that they lead to better treatment outcomes, are cost-effective, and facilitate access to critical services.  Despite this evidence, too few national TB programs have taken up the models as the norm in TB and MDR TB care. 
• Responses to TB/HIV co-infection remain too weak.  Though TB continues to be the leading cause of death among people with HIV/AIDS, the WHO policies on TB/HIV collaborative services have not been consistently implemented, particularly those aimed at reducing the burden of TB among people with HIV/AIDS: 
  • In the past 15 years, new TB cases have more than tripled in countries with high HIV prevalence. People living with HIV/AIDS are more than 50 times likely to develop active TB in a given year compared with HIV-negative individuals.
  • While TB screening can detect risk of TB in people with HIV quickly and cost-effectively, only 630,000, about 2% of people living with HIV were reported as having been screened for TB in 2007.
  • Despite evidence that Isoniazid preventative therapy (IPT) can reduce by 60-80% the incidence of TB disease among people with HIV, only 0.1% of those eligible for IPT have received this lifesaving therapy.
  • Some TB medicines interact with HIV treatment, creating serious side-effects for patients co-infected with HIV that need to be properly monitored and managed.  
  • Even though health care settings pose a two-fold risk of TB transmission to their workers, few health facilities have implemented simple infection control measures to protect health care workers and patients.

 

 

Financial resources and commitments remain insufficient.  The most recent data available on resources allocated to TB programs ($3 billion in 2009) and research ($483 million in 2007) are absolutely insufficient compared to the $5 billion needed for programs in 2009 and the $2 billion for research in 2007.  At these funding levels the targets set by The Global Plan to Stop TB (2006-2015) will not be realized by 2015. International donors and national governments must invest in new diagnostics and treatments to begin addressing individual suffering and face the growing threat of TB.

• Rights-based responses are few and the needs of the most marginalized continue to be unmet. Though respect for human rights and promotion of public health are most effective when they operate jointly, oftentimes TB programs and especially MDR programs have not sought an optimal balance between the two.  Further, accessible and quality services and care for the most vulnerable and socially marginalized, including prisoners, drug users, refugees, and migrant workers are unavailable or extremely limited.

 

• Meaningful civil society participation in policy and program development and implementation remains weak.  The contributions and perspectives of civil society in TB remains relatively absent from most resource, policy and program advocacy and decision making, especially at country level.

 

In light of the current state of affairs, we urge governments, donors, and global policy makers, researchers and fellow civil society activists to:

• Act with a sense of urgency and partner with different stakeholders to devise and implement coherent national plans with targets to provide a comprehensive response to TB.
• Invest the $44 billion for TB control needed between 2009 and 2015 to fully realize the promise of the Global Plan and at least additional $2 billion a year for TB research, critical and currently not covered in the plan.
• Make community based treatment and support, including for MDR TB, and active TB case finding key components of an effective TB response.

 

Though we all must play our part in fighting TB, we also believe that different institutions and stakeholders have specific responsibilities.  In this regard we call upon governments, donors, grant makers, national programs, researchers, international bodies (WHO, UNAIDS and The Stop TB Partnership) and communities of people infected/ affected with TB to urgently address the following areas:

 

 

Policy, Program Development and Implementation

• Governments to ensure that a “patient-centered” approach that respects human rights is a central guiding principle in all TB care efforts.
• Health care personnel, service providers and civil society organizations to ensure that the principles outlined in The Patients’ Charter for Tuberculosis Care are upheld to reduce stigma and combat discrimination.
• National TB programs to implement the WHO algorithm to diagnose smear negative and extra pulmonary TB as well as expand access to culture and drug susceptibility testing.
• National TB Programs to partner with civil society organizations to actively find TB cases in the community in order to prevent TB transmission and deaths due to undiagnosed TB.
• National TB and AIDS Programs to collaborate to achieve Universal Access to TB/HIV services by 2010 in line with the Global Plan and UNAIDS targets.
• National AIDS Programs to shoulder their responsibility to ensure that every person with HIV is regularly screened for TB and provided treatment and/or prevention as appropriate and that every AIDS clinic employs infection control measures to reduce TB transmission.
• The Stop TB Partnership and WHO to take a greater leadership role in catalyzing resources as well as providing countries policy guidance and technical support to address the challenges for TB control including laboratory infrastructure, community-based DOTS, TB/HIV co-infection and MDR-TB.
• National TB Programs should take up the call by the Global Fund Board urging countries to submit proposals to scale up laboratory capacity and community based management of M/XDR-TB cases.
• National TB and HIV/AIDS Programs should take up the call by the Global Fund Board to include and implement significant robust TB interventions in the HIV/AIDS proposals and HIV/AIDS interventions in TB proposals.
• Donors to immediately provide new pledges to fill the $5 billion gap at the Global Fund for AIDS, TB and Malaria-the largest external TB financier-and to ensure the promised scale up of programs is realized.
• Donors to work with the World Health Organization (WHO) and Stop TB Partnership, to harmonize their indicators and monitoring and evaluation framework to reduce the burden on fund recipients.

 

Research and New Tools

• Researchers to work collaboratively and with a sense of immediacy to ascertain the best use of currently available tools and develop and advocate for funding for a comprehensive research agenda that takes into account the specific needs of pediatric TB patients, patients co-infected with HIV and other common co-morbidities such as Hepatitis C. Less toxic, more potent drugs to shorten the length of treatment and address drug-resistant TB are urgently needed.   
• Researchers to prioritize the development of new diagnostic tools that can provide faster and more accurate TB diagnosis for smear positive, smear negative and drug resistant TB, including diagnostics appropriate for children, HIV co-infected patients and for use in resource-poor settings. There is a desperate need for new diagnostic tools that are simple, reliable and field adapted.
• Researchers, funders, and National TB Programs (NTP) to work together to strengthen research infrastructure in countries with high burden of TB to ensure that there is adequate capacity to conduct research to develop new tools as well as learn about the best strategies to implement existing tools.
• Implementers and funders to ensure that new diagnostic tools and drugs developed are made available and accessible in the countries most in need.

 

Civil Society Participation

• UN agencies, donors and governments to encourage, and support civil society participation at national and international forums and promote trained community members as active implementers and advocates of the response.  This support needs to include training and funding for the civil society members so that they may fully participate in decision making and seek broader community input in setting the agenda for the TB response.
• People with HIV and other communities who are disproportionately impacted by TB to learn about our rights and responsibilities as described in the The Patients’ Charter for Tuberculosis Care and to build our science, research, and policy literacy so that we can fully participate in TB program and policy formulation.
• National TB Programs to clearly outline the role of civil society in TB control efforts in their national plans.
• Researchers to harness the knowledge and activist power of communities, especially in whom research is being conducted, to advocate for resources for research and the translation of research findings into sound policy and programs.
• Civil society to play a critical role in advocating for the mobilization of resources to meet Global Plan targets and for the Global Fund which has been critical in providing resources for TB control in high TB-burden countries.

 

COMMUNITY ACTION CALL TO GLOBAL TUBERCULOSIS CONTROL AND PATIENT CARE  MINISTERIAL MEETING OF HIGH M/XDR-TB BURDEN COUNTRIES, BEIJING, CHINA

 

Multi Drug Resistant (MDR) and Extensively Drug Resistant (XDR) TB threaten to reverse gains made by TB and AIDS programs.  The high level of mortality amongst people with HIV due to M/XDR-TB necessitates special attention to prevent and treat drug resistant TB among this population.  Infection control and early case detection should be implemented to prevent and detect TB among people with HIV and treatment support should be prioritized to encourage treatment completion.

 

The civil society participants at the 3rd Stop TB Partners Forum in Rio de Janeiro, Brazil, call on participants at this meeting to include the following in the action plans they develop as a group and as countries:

 

• Ensure that necessary diagnostic tests and treatments for drug resistant TB are accessible wherever M/XDR-TB are found.  Support the development of and ensure access to new diagnostic tools that can be used at the point-of-care, and treatment regimens that are proven effective in children and compatible with HIV medications.
• Invest at least the $270 million needed each year between 2009-2015 to scale up laboratory capacity to provide Universal Access to culture and drug susceptibility testing and develop national and regional laboratory indicators to measure progress.
• Make community-based care for MDR-TB, which has been shown to lead to better treatment outcomes, be cost-effective, and facilitate access to critical services, a norm in your national MDR-TB programs. 
• Mandatory hospitalization should not remain the primary response to MDR-TB treatment, as it overburdens an already stretched health system, infringes on the rights of patients and does not guarantee appropriate and quality care or treatment success
• Ensure that all TB patients, including the most marginalized in society are able to receive treatment that respects their human rights and ensures treatment success.

 

 

 

 

 

The Stop TB Partnership’s response to the economic crisis. By Marcos Espinal

 

The Stop TB Partnership is making certain that all major advocacy events, opportunities and high-level activities during 2009 include top-line messages highlighting the threat of the financial crisis and the potentially disastrous effects it could have on tuberculosis programmes around the world. The global economy will be a major focus of the meeting of the Stop TB Partnership Coordinating Board and the ministerial-level discussions during the Partners’ Forum in Rio in March.

 

We are strengthening resources allocated to advocacy campaigns and products that will explain and stress the risks associated with cutting  funding for TB.  We also will reinforce strategic alliances with partners , governments  and new donors to ensure funding for TB is preserved and continue to increase in the years to come in line with the needs estimated in the Global Plan to Stop TB.  We know that national leadership—especially in countries with strong, emerging economies—will be crucial to sustaining finance for TB in the months and years ahead. Encouraging those countries to move forward vigorously on TB control will be an important objective for us.  

 

The Partnership has developed an advocacy strategy for 2009 that will focus in three fronts:

—To use thematic issues (TB/HIV, MDR-TB, Research) as drivers of awareness, commitment and action from decision makers.

–To sustain and enhance the profile of TB within prevailing development and policy agendas by targeting key endemic and donor countries in light of the important role emerging economies are and will take in the current global economic crisis.

–To make strengthen strategic alliances with key partners for advocacy purposes.

 

How can Partners get involved ?

 

The Advocacy Network is being developed to expand the number of partners engaged in TB advocacy activities and will be increasing its outreach though ramped up communications to partners. We are also developing web-based  tools for disseminating common messages to partners in the network.

 

The Partnership  has just decided to create a  new Advocacy Advisory Committee, whose role is to advise the Coordinating Board and Partnership Secretariat  on advocacy matters including strategies and work plans.  This committee is bringing together 8-10 top experts on different advocacy fronts.   

 

The Partnership will soon be launching a web-based social networking platform for the global community engaged in the fight against TB. This platform will offer unprecedented opportunities for partners to work collaboratively on advocacy strategy and messages.

 

 

 

 

 

 

 

How will the world begin to see TB care as a smart investment? by Bobby Ramakant

Unless the tuberculosis (TB) advocates reach out to decision makers to impress upon them the urgency of strengthening TB care and control programmes, the global economic meltdown is likely to threaten to reverse the gains made in TB care over past decades. “I believe we should not lower our sights one bit. Rather, we should broadcast far and wide irrefutable arguments for more and better TB control now.

The fight against TB is more than a humanitarian cause – it is also a smart investment, at a time when many investments seem insecure” wrote Dr Marcos Espinal,  on this blog. Time is running out. How can the world begin to see TB care as a smart investment? The cross-cutting linkages of TB control to other development issues – need to be more highlighted, more pronounced and worked upon in terms of advocacy, outreach and engagement. For example, those working on poverty, health systems, HIV, and other connected issues, need to say the same – ‘TB control is a smart investment!’ For instance, at least in high burden TB countries, with TB continuing to the biggest cause of death for people living with HIV (PLHIV), the AIDS advocates should be the lead partners in TB care initiatives – they are demonstrating the leadership in some communities but this certainly needs to be happening more often wherever synergy is most appropriate. TB and HIV programmes need to join forces to improve TB and HIV responses locally. With the economic recession taking its toll in the developing world as well, the need to forge effective and genuine partnerships with different stakeholders was rarely so compelling! Promoting greater transparency and participatory approaches in our efforts to engage allies in TB care and control, might prove to be definitive on how effectively we can convince the world that TB care is a smart investment.

 

In a time of crisis, by Dr Marcos Espinal, Executive Secretary of the Stop TB Partnership

In this time of economic uncertainty, which some are calling the winter of our hardship, people engaged in the fight against tuberculosis may believe we face hard choices. We can’t do everything we planned in 2009 – so what will we sacrifice? Where do we cut?

 

Some may be asking these questions, but I will not. I believe we should not lower our sights one bit. Rather, we should broadcast far and wide irrefutable arguments for more and better TB control now. The fight against TB is more than a humanitarian cause – it is also a smart investment, at a time when many investments seem insecure.

 

A little more than a year ago a World Bank research report found that countries with the world’s highest numbers of TB cases could earn significantly more than they spend on TB diagnosis and treatment if they signed onto the Stop TB Partnership’s Global Plan to Stop TB. The study, which was commissioned by the World Bank on behalf of the Stop TB Partnership and funded by the Bill and Melinda Gates Foundation, made abundantly clear that the economic benefits of TB control are greater than the costs. Most highly affected countries could gain nine times or more their investments in TB control.

 

The study was published a year ago, but we have only begun the work of persuading decision makers everywhere that fighting TB is a matter of economic survival for many, many countries.

 

It’s our job to convince them. If we don’t, budgets for TB control and research will almost certainly be cut.

 

You can bank on that.

 

 

What can we do with our anger? by Paul Thorn, originator of the Tuberculosis Survival Project

I really wish that I could go to the Stop TB Partnership Forum in Rio. Unfortunately I need to have a vaccine for yellow fever, however it is a live vaccine. I am HIV-positive and my CD4 count is very low and I have been advised by my doctor against having it. Hey ho! But it doesn’t stop me from participating in ways, for example in this blog.
 
I have worked in the field of TB since 1995. I was inspired to get involved because of my own experience of MDR-TB, and on learning that multidrug-resistance is a man-made problem. It makes sense to me that the solution must therefore be man-made also. I wan’t to play my part in being part of the solution.
 
I wonder sometimes what motivates other people, especially the TB/MDR-TB affected community to get involved. It isn’t the money that is for sure, LOL! For me the motivation is my anger. How can we have gotten to this place? The crisis the world faces on TB is shocking and unacceptable.  I want to channel my anger into something constructive. I know for some others motivation springs from a  sense of injustice about inadequate access to treatment in their own countries, for some it may even be a religious, or spiritual calling? I am interested to know what other instincts or reasons inspire and motivate others to get involved in the battle against TB.