WHO Global Task Force on TB Impact Measurement. Multi-country workshop on TB prevalence surveys and TB surveillance. Accra, Ghana, 29 April 3 May 2013

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1 WHO Global Task Force on TB Impact Measurement Multi-country workshop on TB prevalence surveys and TB surveillance Accra, Ghana, 29 April 3 May 2013 Workshop Report

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3 BACKGROUND The WHO Global Task Force on TB Impact Measurement was established in June Its mandate is to produce a robust, rigorous and widely-endorsed assessment of whether the 2015 targets set for TB control are achieved at global level and for each WHO region; and to help build national capacity in monitoring and evaluation. The 2015 global targets are that TB incidence should be falling, and TB prevalence and mortality rates should be halved compared with The Task Force is pursuing three major strategic tracks of work to fulfil this mandate. These are: Surveys of the prevalence of TB disease in a set of global focus countries. The global focus countries were selected by the Task Force in 2007 and include Bangladesh, China, Cambodia, Ethiopia, Ghana, Indonesia, Kenya, Malawi, Myanmar, Nigeria, Pakistan, the Philippines, Rwanda, South Africa, Tanzania, Thailand, Uganda, Viet Nam and Zambia; Strengthening surveillance, to progress towards the goal of directly measuring the burden of disease due to TB (cases and deaths) from notification and vital registration data; and Periodic updating of methods used to translate data from surveillance systems and surveys into estimates of disease burden. WHO has led efforts to provide guidance and coordination of technical support to countries since December Since 2009, this has included holding global workshops that bring together global focus countries to review progress, share results and discuss lessons learned. Workshops were held at WHO headquarters in Geneva (2008, 2009); Addis Ababa, Ethiopia (2010, in association with the launch of the prevalence survey); and Cambodia (2011, in association with the implementation of a repeat survey). A workshop on the design of repeat surveys in Asia was held in February By early 2013, enormous progress with the implementation of TB prevalence surveys has been made. Almost all global focus countries were on track to conduct a first or repeat survey by TB prevalence surveys are an interim solution for measuring the burden of disease caused by TB. The long-term goal is direct measurement using routine surveillance data (notification data for TB incidence, and a national vital registration system for TB mortality). In 2012, WHO developed a checklist, the standards and benchmarks for TB surveillance and vital registration systems, to assess a national surveillance system s ability to accurately measure TB cases and deaths. Based on the assessment, gaps and unmet M&E needs in national surveillance systems can be identified and strategies to address those needs developed. Starting in January 2013, the aim is that systematic assessment of TB surveillance using the checklist and the development of a related M&E investment plan are integrated and institutionalized within the grant processes of the Global Fund. WHO and the Global Fund have signed a collaborative agreement for 2013 and 2014 to jointly support use of the checklist and development of related M&E investment plans in 15 of the Global Fund s 32 highburden and high-impact countries. 2 Following six previous global workshops on TB prevalence surveys, a multi-country workshop was organized by the TB monitoring and evaluation team in WHO headquarters (HQ), in collaboration with the African Regional Office (AFRO) and the WHO Country Office in Ghana, from 29 April 3 May. Ghana was the selected venue because the prevalence survey started in March 2013, providing an opportunity to observe central and field survey operations. Given the recent development of the TB surveillance checklist and the plan to apply it in high-burden and high-impact countries, the workshop also focused for the first time on TB surveillance as well as TB prevalence surveys. WORKSHOP FUNDING The workshop was funded from a grant from the Bill and Melina Gates Foundation, a grant from USAID through the TB CARE program, and the Global Fund. 1 Full details of the Task Force s work are available at 2 These countries are 18 focus countries selected by the Global Fund s Technical Evaluation Reference Group (Cambodia, Côte d Ivoire, DR Congo, Ethiopia, Kenya, Haiti, India, Malawi, Mozambique, Myanmar, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Ukraine, Zambia, and Zimbabwe); seven additional high impact countries (Bangladesh, China, Ghana, Indonesia, Pakistan, Philippines and Sudan); and a further seven countries (Angola, Madagascar, Namibia, Papua New Guinea, Thailand, Swaziland and Viet Nam). 1

4 OBJECTIVES The workshop had six objectives: 1. To present and discuss the findings from national TB prevalence surveys recently completed in six countries: Gambia, Nigeria, Pakistan, Rwanda, Tanzania and Thailand. 2. To review the current status of preparations or implementation of national TB prevalence surveys in seven countries where surveys are planned in 2013 and 2014 (Ghana, Indonesia, Kenya, Malawi, South Africa, Uganda, Zambia) and to identify actions required to enable these surveys to start or to enable ongoing surveys to be completed to a high standard. 3. To discuss how findings from prevalence surveys can be combined with other data to inform re-estimation of TB disease burden. 4. To present and discuss the TB surveillance checklist of standards and benchmarks and how it can be used as the basis for strengthening surveillance, including sharing of results from five countries where the checklist has recently been applied. 5. To discuss actions required to strengthen TB surveillance, with particular attention to a) electronic recording and reporting and b) inventory studies to measure under-reporting of TB cases to national surveillance systems. 6. To discuss the status of drug-resistance surveillance (DRS) and monitoring of the programmatic response to MDR-TB, and actions needed to improve data and estimates. EPECTED OUTCOMES The expected outcomes of the workshop were as follows: 1. All participants are fully informed about the currently-available results and lessons learned from the national prevalence surveys implemented in Gambia, Nigeria, Pakistan, Rwanda, Tanzania and Thailand. 2. All participants are aware of the latest status of surveys due to be implemented in 2013 and 2014 in Ghana, Indonesia, Kenya, Malawi, South Africa, Uganda, Zambia, with any actions required to ensure these surveys are implemented according to the standards established in the WHO handbook on TB prevalence surveys identified. 3. Re-estimation of disease burden discussed with country teams from Gambia, Nigeria, Pakistan, Rwanda, Tanzania and Thailand. 4. All participants are aware of the TB surveillance checklist of standards and benchmarks and results from five countries and there is increased interest in and capacity to use it at global, regional and country levels. 5. Increased knowledge and awareness of the role and benefits of a) electronic recording and reporting and b) inventory studies to measure TB underreporting, and identification of countries where their implementation could be warranted. 6. Status of DRS among participating countries and actions needed mapped out, with increased knowledge and understanding of the indicators required for future monitoring of the programmatic response to MDR-TB. PARTICIPANTS The participants invited to the workshop were: 1. Representatives from 13 countries where a prevalence survey has been recently completed or is due to be implemented in 2013 or 2014; almost all countries are also in the list of countries where use of the WHO TB surveillance checklist has been identified as a priority. 2. Representatives from Cambodia and Ethiopia, where a national prevalence survey was completed in 2011 and 2010, respectively. 3. Representatives from technical and financial agencies and consultants actively engaged in supporting national TB prevalence surveys and strengthened TB surveillance. These included US-CDC, KNCV, RIT/JATA, UK Medical Research Council (MRC)-Gambia, Public Health England (formerly the Health Protection Agency), and the Global Fund. The total number of participants who attended the workshop was 68. A full list with names and addresses is provided in Annex 1. 2

5 WORKSHOP STRUCTURE AND METHODS The first four days of the workshop were a mixture of a) presentations, b) plenary discussions and c) group work with feedback in plenary (see Annex 2 for the Agenda). The final day was used for a field trip to observe central and field survey operations in Ghana. BRIEF SUMMARY, BY MAJOR WORKSHOP SESSION AND TOPIC 1. National TB prevalence surveys: results and lessons learned from 2011/2012 surveys There were six presentations on the provisional results and lessons learned from surveys in the Gambia, Nigeria, Pakistan, Rwanda, Tanzania and Thailand. Some of the main points are summarized below. Further details can be found in the six presentations given on Day 1 (see Task Force website). a) The Gambia The survey was successfully completed in January Limited human resources prolonged field operations to 14 months, but this also provided extra time to create a well-organised data management system. The estimated prevalence was lower than previously estimated with peak prevalence in the year age groups. Most cases were smear-negative, and just over half the cases would have been detected with the current screening strategy. Few of the prevalent smear-positive cases were known to the NTP. The MGIT contamination rate was high. b) Nigeria Field operations were completed in October Technical assistance was provided by WHO and CDC-USA. A workshop attended by Task Force members (WHO and CDC-USA) in March 2013 was used for data cleaning and analysis. The overall participation rate was low, at 56% (likely due to the residency criteria). There were laboratory challenges during survey implementation; these arose because it was impossible to review the work being done in all laboratories during the survey, due to security issues. pert MTB/RIF has been used to help finalize laboratory results. The estimated prevalence is much higher than previously estimated. Most survey cases were smear-positive and symptomatic, with the prevalence to notification ratio being very high especially in men and in the elderly. The results show that a top priority is strengthening of basic DOTS services. c) Pakistan The survey is one of the largest ever undertaken. It was completed in December 2011, with technical assistance from KNCV. There have been major challenges with data cleaning, which was still ongoing at the time of the workshop and is expected to be completed around July. Data cleaning problems have arisen as a result of problems in merging databases from different forms, since PIN numbers were not always correctly recorded or entered, as well as some other data management challenges. This survey highlighted the key importance of data management in a survey and offers useful lessons learned for other countries. Final results are expected around October d) Rwanda The survey was successfully completed in December 2012, with a very high participation rate (>90%). Technical assistance was provided by KNCV. Challenges that were overcome included initial delays (6 months) for procurement, some malfunctioning of -ray machines in the field and limited laboratory capacity. Prevalence appears to be lower than previously estimated, and less than 40% of survey cases would be detected with the current NTP screening strategy. Provisional results will be disseminated during the Union conference in Kigali in June. 3

6 e) Tanzania The survey was completed in November 2012, with technical assistance from KNCV. At the time of the workshop, data analysis had not been finalized and discussed by the Steering Committee and other stakeholders, and therefore no results were available for presentation. Challenges faced during the survey included delays in disbursement from the Global Fund, the breakdown of some CR equipment and vehicles, the sometimes excessive workload of field staff (leading to adjustments to rest days) and data entry backlogs. It was agreed during the workshop that it would be important to have Task Force peer-review of results and their implications prior to wide and high-level dissemination of results. f) Thailand The survey was successfully completed in all non-bangkok clusters in October Technical assistance has been provided by RIT/JATA and WHO. Major challenges included participation among the middle-class and rich urban areas, enrolling non-thai immigrants, and the initial use of multiple teams with limited experience. The estimated prevalence was slightly higher than the previous estimate. The prevalence:notification ratio is much lower than in other countries in the region. Although the survey is not yet complete, the approach to data management (including realtime electronic entry of key variables in the field and close survey monitoring by Task Force technical advisors and USCDC Bangkok staff) has allowed for very prompt analysis of data and production of provisional results, along with prompt case management. 2. Latest status of surveys in countries where surveys are planned in 2013, and lessons learned that should be applied in ongoing and future surveys The latest status of surveys in other countries was presented by each country team. The status can be summarized as follows: Ghana and Indonesia have just started their surveys. Both surveys were delayed by procurement and funding delays. Malawi and Kenya expect to start their surveys later in Both have experienced challenges with procurement (laboratory consumables and -ray equipment, respectively). South Africa, Uganda and Zambia have experienced procurement challenges that have delayed the commencement of the surveys. Other issues that have caused delays include finalization of protocols, selection of an implementing partner (the School of Public Health has now been selected in Uganda), identification of a full-time survey coordinator and overall human resources and laboratory capacity. It was evident throughout the workshop that country country collaboration has a key role in successful survey preparations and implementation. It is essential that the seven countries implementing surveys in 2013 or planning to start them in 2013 or 2014 draw upon the rich resource of experienced survey coordinators and other staff when finalizing their own plans and during survey implementation. Full details are available in the Prevalence Survey Progress Update, April 2013 (see background documents for the meeting available on the Task Force website). Overall commentaries from those who have provided technical assistance to recently completed surveys There were ten workshop participants who have all played a key role in providing technical guidance and support to recently completed surveys (Marina Tadolini, Norio Yamada, Amal Bassili, Nico Kalisvaart, Babis Sismanidis, Hazim Timimi, Julia Ershova, Irwin Law, Eveline Klinkenberg and Ikushi Onozaki). On the first day of the workshop, they each identified the top three lessons learned that they thought were of greatest importance and relevance to other countries. A summary of the 4

7 feedback is provided in Table 1. The fact that data management was the topic on which most comments were made illustrates the need to pay considerable attention to ensuring good data management practices. It was noted during the commentaries that the Task Force has established a data management group, convened by WHO and including members from CDC-USA and KNCV, to peer-review data management plans in advance of the start of surveys and to serve as a resource on data management once surveys are underway. It was also noted that peer-review of the analysis of survey results is also important, especially for the more sophisticated approaches including adjustment for missing data that are now recommended and of particular importance for surveys with lower participation rates. Table 1: Key lessons for future surveys identified by those who provided technical assistance to recent surveys Data management in prevalence surveys: key points from group work The following points (some of which reinforce those in Table 1 above) are worth highlighting from the breakout group discussions (Days 3 and 4) on data management: A barcoding system is an important aid for minimizing data transcription errors, and is an effective way to track participants and their related paperwork and specimens. Data management in the laboratory should be given much higher priority. To date, this aspect of a survey appears to be relatively neglected, with preparations focused on field operations and improving technical aspects of laboratory capacity. High-quality data management in the laboratory is an essential component of any survey. Optimising the number of identifiers in the paperwork, chest -rays and specimen labelling will help to minimize data handling errors, and improve the efficiency of appropriate case management. Identifiers such as survey ID numbers, serial numbers, names and age/date of birth should be considered. Identifiers that could link results to a specific individual should be removed from a data set before data are analysed by a third party, in accordance with any legal and ethical requirements. Questionnaires should be kept simple and well structured. The number of forms should be kept to a minimum, with data collected participant-wise (i.e. forms follow the participant, as opposed to separate forms being completed in different places with later assembling of all documents for each participant); 5

8 The ethics of case management should underlie good data management. Participants need to be promptly informed about correct results. Reviewing all positive laboratory cases with their associated paperwork and radiological results by a central panel is vital. Such a review will also facilitate the timely production of prevalence estimates. If resources allow, data entry in the field should be used to improve data quality and allow timely follow-up of any data discrepancies and subsequent data analysis. To maintain data quality in the field, dedicated data checkers should be part of the field team who document and follow-up on any data errors in the paperwork. Intermittent and frequent analysis of available data should be done, to allow prompt feedback to field teams and prompt recommendations and corrective actions to address any problems. Paper-based data collection is challenging and digital data collection and processing is advised e.g. real-time data processing and validation in the field. A local IT expert(s) is required from the outset to develop and consistently maintain such a system. 3. Re-estimation of TB disease burden Discussions were held with the four countries that had completed surveys and presented provisional results during the workshop. The main points were as follows: The Gambia, Nigeria and Rwanda. Prevalence estimates will be updated based on the final results of the prevalence surveys (adjustments of survey results will be needed to account for childhood TB and extra-pulmonary TB). Estimates of incidence and mortality may need to be revised as well. Final results are expected after July 2013, which is too late for them to be incorporated in the 2013 Global TB Report. However, an addendum may be posted on line as necessary, along with updated datasets and country profiles. Pakistan. A meeting will be organized between WHO/TME and the NTP Pakistan during the Union Conference in Paris (tentatively 31 October 2013), at which time the final results from both the prevalence survey and the inventory study to measure TB under-reporting are expected to be available. The meeting will be used to reach a consensus on updated estimates of TB burden, which will be published online with an updated country profile. An overview presentation (Philippe Glaziou) on TB epidemiology and methods for estimating TB disease burden, with particular attention to prevalence surveys and the key role of strengthened surveillance, is available on the Task Force website (see Day 2). 4. The TB surveillance checklist and results from 5 countries The TB surveillance checklist of standards and benchmarks was presented, along with an explanation of the development process including pilot-testing in 11 countries and re-testing in a subset of these countries. This was followed by presentations of the results from using the checklist, including an associated investment plan, for five countries (Ghana, Indonesia, Kenya, Nigeria and Uganda). Key points that were highlighted included: The checklist offers a standardized and systematic approach to assessing the ability of a national surveillance system to directly measure the number of cases and deaths due to TB. The ultimate goal is to directly measure TB incidence and mortality from surveillance data. Recommendations based on findings from the surveillance assessment can be used to develop an investment plan of activities that aim to close any surveillance gaps that are identified. The Global Fund and WHO have developed a joint strategy to implement the checklist in high burden and high impact priority countries, with results used to inform investments through Global Fund grants and investments by other partners. The checklist has been implemented in seven countries: Cote d Ivoire, Ghana, Kenya, Indonesia, Nigeria, Uganda and Viet Nam. In Ghana, Indonesia and Nigeria the assessment was conducted just prior to a programme review. Investment plans based on recommendations to strengthen surveillance in the country have been developed. In Indonesia, this has already resulted in mobilization of funds to strengthen surveillance using the country s existing grant from the Global Fund. 6

9 In break-out group work, seven additional countries expressed interest in using the TB surveillance checklist (see also Next steps described on pages 9 and 10): Rwanda. A new national strategic plan for TB control will be developed in mid-2013 and the assessment would be very useful to inform the M&E component of the plan. Technical assistance from KNCV is available for this purpose via TB CARE, provided it happens before the end of September This could be linked to remaining missions that are planned for the prevalence survey. Ethiopia. A national programme review is being planned, that will include an epidemiological assessment; this could be linked to a surveillance assessment. KNCV would be able to provide technical assistance. The programme review will be followed by the development of a national strategic plan. Zambia. An assessment using the checklist could be done as part of their internal annual joint health sector review. CDC-USA would be able to provide technical assistance. Pakistan. The surveillance assessment will be done during the joint programme review scheduled for November 2013, with support from WHO. Malawi. The team was interested in using the surveillance checklist but would need some external support and also need to discuss the assessment with other staff in the NTP. South Africa. It was agreed to schedule a mission by WHO shortly after the workshop to allow for further discussion of the TB surveillance assessment, alongside discussions about the prevalence survey. Tanzania. The team was interested in using the surveillance checklist. Further details are available in an overview presentation (Emily Bloss), in the five presentations of the results from the surveillance assessments conducted in Ghana, Indonesia, Kenya, Nigeria and Uganda (see presentations from Days 2 and 3 of the meeting on the Task Force website) and in the background documents for the meeting (see the document with the surveillance checklist and accompanying user guide). 5. Electronic recording and reporting, and inventory studies Electronic recording and reporting There is increasing interest in the adoption of electronic recording and an increasing number of countries have moved to implementation. Key points from the overview presentation and break-out discussions in group work were: The benefits of case-based electronic recording and reporting systems include better data quality, reduced workload, real-time data access, timeliness, flexibility, data analysis and a multi-directional (not only bottom-up) approach to reporting; Ethiopia. The Ministry of Health has an integrated paper-based reporting system that includes only a few TB indicators (particularly at the national aggregate level). There are plans to move to integrated electronic reporting by Ghana and Indonesia. Electronic recording and reporting systems are currently under development. In Ghana the system will communicate with the Ministry of Health s integrated electronic reporting system and in Indonesia the system is due to be piloted in July Kenya. The TIBU system was recently launched. It uses tablets at district level. The system was discussed in detail, particularly the development and rollout process and the lessons for other countries from the Kenyan experience. South Africa. The laboratory electronic database has been used to clean up the electronic TB surveillance database. This should be completed by the end of The Kenyan electronic recording and reporting system was highly praised during the workshop as a model that could be used by other countries. General guidance is available in the WHO guide on electronic recording and reporting for TB care and control, copies of which were distributed to all workshop participants. The guide is available on the Task Force website. 7

10 Inventory studies Inventory studies can be used to assess the extent to which TB surveillance misses diagnosed cases of TB due to under-reporting (and in certain circumstances can be used to estimate TB incidence). Inventory studies are necessary to demonstrate that one of the standards in the TB surveillance checklist is met i.e. that under-reporting of diagnosed cases should be <10%. WHO has recently issued a guide on inventory studies to measure under-reporting, and copies were distributed to all workshop participants. An overview presentation about inventory studies was given, followed by a presentation of the provisional results from an inventory study in Pakistan (see presentations by Philippe Glaziou and Razia Fatima, Day 3). In break-out discussions during the workshop, Indonesia, Kenya, Nigeria, South Africa and Thailand expressed interest in implementing an inventory study 6. Anti-TB drug resistance surveillance The latest status of global progress in surveillance of drug resistance was presented. The status of surveys in six countries was then discussed during break-out group work. The key points were: Ghana. No representative survey has ever been conducted in the country. The NTP agreed to plan a survey in Technical assistance from WHO will be sought. Indonesia: The first national drug resistance survey is planned in The next steps for protocol development were discussed. Pakistan and South Africa: Progress in implementing the ongoing national drug resistance surveys was reviewed. Options for reducing culture contamination were discussed. Rwanda: A second national survey is planned to start before the end of The sample size was reviewed using new data from the routine surveillance system in Kigali. Zambia: Final results of a survey conducted in 2007 have not yet been released due to discordances among the different laboratory methods used (LJ media, MGIT, LPA). The NTP agreed to consider the results obtained with LPAs as final and will share them with WHO. Further details are available in an overview presentation (Matteo Zignol) and in the Drug Resistance Surveillance (DRS) Progress Update, April 2013 (see background documents for the meeting available on the Task Force website). 7. Definitions and reporting framework for tuberculosis 2013 revision WHO last revised the TB surveillance definitions and reporting structures for TB in Since then, WHO-approved rapid molecular diagnostics have been widely introduced and the treatment of drugresistant tuberculosis has being scaled-up, necessitating adjustments to the way cases and outcomes are defined and reported. WHO held a technical consultation on the required revisions in May 2011; extensive consultations with countries and partners, and pilot testing in 7 countries, followed. The 2013 framework was presented during the workshop. It was highlighted that: Cases are now classified as bacteriologically confirmed (by smear, culture or WHO-approved rapid tests) or clinically diagnosed. For the monitoring of enrolment and outcomes, rifampicin-resistant cases of TB may be enumerated with MDR-TB cases. The definitions of Cured, Completed and Treatment Failure for patients on second-line MDR- TB treatment have been simplified and can now be applied to 9-12 month MDR-TB regimens. Register templates now provide for recording of the results from molecular tests. The revised definitions will be used in WHO s 2014 round of global TB data collection. The new definitions and reporting framework are easier to introduce if electronic recording and reporting is already in place. The main issues discussed following the presentation were about the separate management of patients on basic TB and on second-line treatment for the purposes of outcome monitoring. Some concerns were expressed that the changes will take several years to implement in certain countries and support would be needed to train health care workers to apply the definitions properly and report cases according to the revised framework. 8

11 NET STEPS AT COUNTRY AND GLOBAL LEVEL In the last session of the workshop, key take-away points and next steps were discussed and summarized in country groups, and then presented in plenary. A summary is provided below; further details are available in the country-specific presentations given on Day 4. Global level WHO to organize small prevalence survey data analysis workshop in Q (to allow sufficient time for data cleaning for countries that have recently completed surveys) to ensure a common approach to analysis, especially accounting for missing data and related adjustments for non-participants. WHO to provide country-specific support to finalization and dissemination of results from prevalence surveys, as appropriate based on close consultation with countries. WHO to organize a one-day workshop on prevalence surveys in association with the Union conference on 31 October; WHO and partners to continue to coordinate or provide direct support to surveys and surveillance assessments according to need and requests. Country by country Country Ethiopia Gambia Ghana Indonesia Kenya Malawi Nigeria Next steps Surveillance: Discuss potential opportunity to conduct TB surveillance assessment linked to upcoming programme review with NTP. Work with NTP on best approach to adopting electronic recording and reporting (ERR). Prevalence survey: Finalize analysis of prevalence survey data, including in global workshop. Surveillance: Discuss potential move to electronic recording and reporting with NTP. Prevalence survey: Reduce laboratory workload by cutting back on MGIT. Rotate data entry among lab technicians (full-time job for 1 week, rotating among staff). Increase frequency and effectiveness of communication among survey coordinators, field teams, laboratory, health system. Create more data-checks in database, conduct data verification/have data checker in field. For electronic data, secure ownership of software, ensure back-up off-site, introduce unique identifiers to avoid duplicates. Prevalence survey: Double-check paper-based and electronic data daily in the field. Ensure more supervision from laboratory working group and experts. Ensure positive results reported promptly. Surveillance: Pilot ERR system in August. Implement DRS in Pilot inventory study using prevalence survey data and laboratory data. Prevalence survey: adopt new study case definitions. Surveillance: DRS to begin just before prevalence survey. Link TIBU to the laboratory management information system. Prevalence survey: Update protocol and SOPs to reflect recommendations by 15 May; complete -ray procurement by 15 May; refresher training + pre-visit end May; TA mission 1 st week June. Prevalence survey: Finalize data analysis, disseminate results, complete survey report. Surveillance: TB surveillance checklist finalize analysis for standards 1.3, 1.6, 1.7; cost investment plan; meet with Global Fund to discuss funding for necessary investments (in country, in Geneva). Implement new case/treatment outcome definitions and associated R&R framework. ERR study tour to Kenya (June), and discuss with other stakeholders; identify TA to assess current HMIS infrastructure and connectivity. Inventory study - pilot in FCT. 9

12 Pakistan Rwanda South Africa Tanzania Thailand Uganda Zambia Prevalence survey: Finalize data cleaning and then data analysis in August (with KNCV, WHO). Re-estimation of disease burden: Discuss with WHO using final prevalence survey and inventory study results on 31 October, at Union conference. Surveillance: Conduct TB surveillance assessment in November, linked to programme review. Scale-up ERR nationwide, following the piloting already conducted in 20 districts. Complete DRS fieldwork in July. Prevalence survey: Finalize analysis including in global workshop (see below). Start to make decision-makers aware of important findings besides the prevalence estimate itself. Request to WHO to inform Global Fund r.e. timelines for finalization of results (6 9 months after data collection is completed is realistic). Re-estimation of disease burden: Ensure good communication of results - especially essential if final results differ from expectations. TB surveillance: Introduce checklist to others in NTP and to M&E division/rbc/moh. Assessment using checklist could be used to provide input to M&E component of new strategic plan for TB control being developed mid-2013 (WHO should formally inform MoH/NTP about the checklist and availability of external support to use it). Start DRS in September In advance, need to review sample size and pay more attention to classification of new and previously treated cases, and consider keeping strains for future use. Revised definitions address current reporting challenges, but training is needed. Guidance requested from WHO about when/how to report using the new definitions. Prevalence survey: Continued consultation with the Steering Committee to resolve the current bottlenecks. Surveillance: Discuss/identify steps required to implement the TB surveillance checklist. Prevalence survey: Ready to support neighbouring countries about to start surveys. Finalize data validation and provisional analysis, and share provisional results with Task Force for review including to assist with interpretation/explanation before final dissemination. Surveillance: Conduct TB surveillance assessment in next 3 months in collaboration with WHO. Conduct second DRS in Improve ERR (currently at different stages countrywide and not functioning well). Prevalence survey: Complete survey in non-bangkok clusters, present results from non-bangkok clusters during joint monitoring mission (JMM) in August Convene panel of experts to review results and complete analysis September December Surveillance: Conduct TB surveillance assessment in July, present results in JMM. Inventory study important for Thailand. Explore existing databases (insurance, drug consumption) and consider possible study design. Complete DRS (ongoing), continue to scale-up ERR. Prevalence survey: Need to get prevalence activities on track: finalize discussions with Ugandan Bureau of Statistics, obtain protocol approval, fast-track MoU with School of Public Health that will be responsible for implementing the survey, recruit survey coordinator, finalize data collection forms (all within 8 weeks after the workshop). Surveillance: Use checklist results as input to programme review planned for September, update quarterly reporting forms, integrate indicators into Uganda DHS: Prevalence survey: Ensure forms are kept simple and use bar codes in laboratories (reexamine their use at the central laboratory). Surveillance: Conduct surveillance assessment using WHO checklist with internal and external TA. Explore ways to implement ERR. Report 2010 DRS results. 10

13 ANNE 1: LIST OF PARTICIPANTS Name Title/Contact address Country Participants Cambodia 1. Dr Peou Satha Ethiopia 2. Dr Eshetu Lemma Vice Chief of Administration Bureau and Chief of ray Unit, National Center for TB and Leprosy Control (CENAT), Ministry of Health Street 95&278 Boeung Keng Kang II, Chamcar Mon District Phnom Penh City, Cambodia Head, Department of Infectious Diseases Research Ethiopian Health and Nutrition Research Institute PO Box 1242 Addis-Ababa, Ethiopia Gambia 3. Dr Ifedayo Adetifa Research Clinician Medical Reesearch Council (UK) Laboratories P.O. Box 273 Atlantic Boulevard, Fajara Banjul, Gambia Ghana 4. Mr Felix Afutu TB Focal Point Surveillance (M&E) TB Control Accra, Ghana 5. Dr Frank Adae Bonsu Programme Manager National TB Control Programme - Disease Control Unit Ministry of Health Box KB 493 Korle-Bu Accra, Ghana 6. Mr Raymond Gockah gockah@gmail.com Survey Coordinator, TB Control Accra, Ghana Indonesia 7. Dr Natalie Laurencia Kipuw laurenkipuw@litbang.depke s.go.id lauren_kipuw@yahoo.com Laboratory Coordinator for Indonesia TBPS c/o NIHRD, Ministry of Health Jl. Kelapa Hijau V Block F3 No.4 Kelapa Gading Permai Jakarata, Utara Jakarta, Indonesia 8. Mr Muhammad Noor Farid mnoorfarid@gmail.com Central Statistics Bureau c/o Ministry of Health, Indonesia Directorate General of Disease Control and Environmental Health Jl. Kalisari III/ Jakarta Timur, Indonesia 9. Dr Dyah Armi Riana dyaharmiriana@gmail.com Section Head of Standardization NTP Control Program. Directorate General of Disease Control and Environmental Health Ministry of Health Jalan Ketumbar Number. 11 KPAD Cibubur East Jakarta Jakarata, Indonesia 11

14 Kenya 10. Dr Bernard Langat 11. Dr Joseph Kimagut Sitienei Global Fund Coordinator DLTLD - MOPHS National Leprosy and Tuberculosis Programme P O Box Nairobi, Kenya Dr Joseph Kimagut Sitienei National TB Programme Manager Division of Leprosy Tuberculosis and Lung Disease Ministry of Health P.O. Box Nairobi, Kenya Malawi 12. Mrs Rhoda Banda rhobanda@gmail.com National Tuberculosis Programme Officer National Tuberculosis Programme Ministry of Health, P/BAG 65 Lilongwe 3, Malawi 13. Dr James Mpunga mpungajay@gmail.com jmpunga@yahoo.com Nigeria 14. Dr Nkemdilim Cynthia Chukwueme dilimcyn@yahoo.com Programme Manager National TB Control Programme Ministry of Health P/Bag 65, Lilongwe, Malawi Programme Management, M & E, Survey and Surveillance, National Tuberculosis and Leprosy Control Programme( NTBLCP), Department of Public Health, Federal Ministry of Health Plot 6 Uyo Crescent, Off Emeka Anyaoku Street, Area 11, Garki Abuja, Nigeria 15. Dr Joshua Obasanya joobasanya@hotmail.com National Coordinator National TB, Leprosy & Buruli Ulcer Control Programme Akwa Ibom House Plot 540, Constitution Avenue Central Business District Abuja 234, Nigeria 16. Dr Gideon Zephaniah gzephaniah@yahoo.com Data Manager, Prevalence Survey Plot 540, Constitution Avenue, Central Area Abuja, FCT, Nigeria Pakistan 17. Dr Qadeer Ejaz ntpmanagerpak@ntp.gov.pk NTP Manager and PPM Focal Point National TB Control Programme Federal Ministry of Health Asghar Mall Road Islamabad, Pakistan 18. Dr Razia Fatima drrazia_fatima@yahoo.com 45 Orchard Scheem Murree Road Islamabad, Punjab, Pakistan Rwanda 19. Dr Patrick Migambi migambi2010@gmail.com migapatrick@yahoo.fr TB Prevalence Survey Coordinator Ministry of Health Kicukiro District Gorara Street Kigali, Rwanda 20. Dr Ndahindwa Vedaste ndahindwa@gmail.com Director of Medical Research Medical Research Center Division Rwanda Biomedical Center P.O. Box 2315 Kigali, Kicukiro District, Rwanda 12

15 South Africa 21. Dr Chikwe Ihekweazu Consultant Medical Epidemiologist Centre for Tuberculosis (incorporating the NTBRL), National Institute for Communicable Diseases 1 Modderfontein Road, Sandringham Johannesburg, South Africa 22. Dr Lindiwe Mvusi MvusiL@health.gov.za Chief Medical Officer National TB Control and Leprosy Programme, Department of Health Private Bag Pretoria, South Africa 23. Dr Ananta Nanoo anantan@nicd.ac.za Epidemiologist Centre for Tuberculosis (incorporating the NTBRL) National Institute for Communicable Diseases 1 Modderfontein Road, Sandringham Johannesburg, South Africa Tanzania 24. Dr Deus Kamara vedastusk@gmail.com Senior Programme Officer National TB and Leprosy Programme Ministry of Health and Social Welfare P O Box 9083 Dar-es-Salaam, Tanzania 25. Dr Sode Matiku smatiku@hotmail.com Monitoring and Evaluation Coordinator Preventive Services, National TB and Leprosy Programme Ministry of Health and Social Welfare P.O. Box 9083 Dar-es-Salaam, Tanzania 26. Dr Blasdus Njako njakobf@yahoo.co.uk Acting Programme Manager National TB and Leprosy Programme Ministry of Health and Social Welfare P.O. Box 9083 Dar-es-Salaam, Tanzania Thailand 27. Dr Sirinapha Jittimanee sxj47@yahoo.com Public Health Technical Officer Bureau of Tuberculosis Department of Disease Control Ministry of Public Health 116 Sudprasert Rd Bangkorlaem Bangkok, Thailand 28. Dr Chawetsan Namwat chawetsan@yahoo.com Director, Bureau of Tuberculosis Department of Disease Control Ministry of Public Health 116 Sudprasert Road, Bangkorlaem Bangkok, Thailand 29. Dr Sriprapha Nateniyom nateniyoms@yahoo.com Senior Expert in Prevention Medicine, Bureau of Tuberculosis Department of Disease Control Ministry of Public Health Tivanond Road Nonthaburi, Thailand Uganda 30. Dr Bruce Kirenga brucekirenga@yahoo.co.uk Head, Division of Pulmonary Medicine Department of Medicine Makerere/Mulago Hospital P O Box c/o WHO Uganda Plot 60, Prince Charles Drive, Kololo, Kampala Uganda 13

16 31. Dr Frank Mugabe Rwabinumi NTP Manager c/o WHO Uganda P O Box Plot 60, Prince Charles Drive, Kololo Kampala, Uganda Zambia 32. Dr Pascalina Chanda-Kapata pascykapata@gmail.com Survey coordinator - Principal Surveillance and Research Officer Department of Public Health and Research Ministry of Health P.O Box Ndeke House Lusaka, Zambia 33. Dr Nathan Kapata nkapata@gmail.com Manager, National TB & Leprosy Specialist Ministry of Health Central Board of Health P. O. Box Ndeke House Lusaka, Zambia Agencies and Others CDC 34. Dr Emily Bloss dpu2@cdc.gov Epidemiologist International Research and Programs Branch, Division of Tuberculosis Elimination Centers for Disease Control & Prevention 1600 Clifton Road MS E Atlanta GA USA 35. Dr Julia Ershova Jhe3@cdc.gov Epidemiologist/Data Manager Division of TB Elimination Centers for Disease Control & Prevention 1600 Clifton Road NE MS E Dr Eugene McCray ecm1@cdc.gov emccray@cdc.gov Atlanta, GA USA Chief, International Research and Programs Branch Centers for Disease Control and Prevention, Division of TB Elimination Centers for Disease Control & Prevention 1600 Clifton Road, Mail Stop E Atlanta, GA USA 37. Dr Patrick Moonan bng3@cdc.gov Acting Team Lead, Programme Strengthening & Epidemiology, International Research & Programs Branch, Centers for Disease Control and Prevention, Division of Tuberculosis Elimination 1600 Clifton Road MS Atlanta GA USA 38. Dr Deanna Tollefson vtu3@cdc.gov International Research and Programs Branch Division of Tuberculosis Elimination Centers for Disease Control and Prevention Corporate Square, Building Atlanta GA USA CDC South Africa 39. Prof. Ehimario Igumbor IgumborE@sa.cdc.gov Public Health Specialist Epidemiology and Strategic Information Branch U.S. Centers for Disease Control and Prevention, PO Box nd Floor, Building 3, Hatfield Square 1140 Prospect Street, Hatfield 0001 Pretoria, South Africa 14

17 CDC Rwanda 40. Dr Claude Uwizeye il.com Global Fund 41. Dr Sai Pothapregada Fund.org TB and TB/HIV Evaluation and Research Specialist, CDC Rwanda, BP Avenue de la Gendarmerie Kigali, Rwanda Senior Specialist, Impact & Evaluation The Global Fund to Fight AIDS, Tuberculosis and Malaria The Global Fund Chemin de Blandonnet Vernier, Geneva, Switzerland Health Protection Agency (HPA) 42. Dr Laura Anderson Laura.Anderson@phe.gov.uk Senior Scientist (Epidemiology) TB Section, Department of Respiratory and Systemic Infections Public Health England 61 Colindale Avenue NW9 5EQ London, United Kingdom 43. Dr Maeve Lalor maeve.lalor@phe.gov.uk Maeve_lalor@yahoo.com RIT/JATA, Japan 44. Dr Yasunori Ichimura icchy@mba.nifty.ne.jp yichimura@earth.nifty.jp 45. Dr Norio Yamada nyamada@tkg.att.ne.jp nyamada@jata.or.jp Epidemiologist Public Health England 61 Colindale Avenue NW9 5EQ London, United Kingdom Respiratory Medicine Unit Chiba University School of Medicine 1269 Aobanomori-koendori I-8-I Inohana, Chuou-ku Chiba-shi Chiba, Japan Director Department of International Corporation, Research Institute for TB (RIT)/ Japan Anti-TB Association (JATA) Matsuyama Kiyose-shi Tokyo, Japan KNCV 46. Dr Nico Kalisvaart kalisvaartn@kncvtbc.nl Senior Consultant Surveillance and Data Management KNCV Tuberculosis Foundation Parkstraat 17 (Hofstaete Building) 2514 JD - The Hague, Netherlands KNCV Ethiopia 47. Dr Eveline Klinkenberg klinkenberge@kncvtbc.nl Senior Epidemiologist Research Unit KNCV Tuberculosis Foundation P.O. Box CC - The Hague, Netherlands KNCV Kenya 48. Dr Osman Abdullah AbdullahiO@kncvtbc.nl KNCV Tuberculosis Foundation Kenya Regional Office for Africa (Kenya) Jumuia Place I, Lenana Road, Kilimani P.O. Box Nairobi, Kenya 49. Dr Rachael Ochola ocholar@kncvtbc.nl KNCV Tuberculosis Foundation Kenya Regional Office for Africa (Kenya) Jumuia Place I, Lenana Road, Kilimani P.O. Box Nairobi, Kenya 15

18 Others 50. Dr Jaap Broekmans Chair, WHO Global Task Force on TB Impact Measurement and Former Executive Director, KNCV Groot Hertoginnelaan EJ - The Hague, Netherlands 51. Dr Marie-Eve Raguenaud eve_raguenaud@hotmail.com 17 Rue de la Pierre Plastique Poitiers, France 52. Dr Marina Tadolini mtadolini@hotmail.com Scientist Via Mazzini Bologna, Italy WHO Regional/Country Office Staff 53. Dr Amal Bassili bassilia@who.int bassilia@emro.who.int Medical Officer, STB EMRO/STB Stop Tuberculosis WHO Egypt 54. Dr Isamel Hassen Endris ismaelh@et.afro.who.int Medical Officer WHO/Ethiopia 55. Dr Joseph Imoko imokoj@who.int imokoj@ug.afro.who.int National Professional Officer WHO/Uganda 56. Mr Hillary Kipruto kiprutohi@who.int Kiprutoh@who.int Statistician WHO Kenya 57. Dr Wilfred Nkhoma NkhomaW@zw.afro.who.int Coordinator, IST/ESA AF/CDS Communicable Diseases WHO/Zimbabwe 58. Dr Felicia Owusu-Antwi owusuantwif@who.int National Professional Officer WHO/Ghana 59. Dr Philip Patrobas Dashi patrobasp@who.int patrobasp@ng.afro.who.int National Professional Officer WHO/Nigeria 60. Dr Babatunde Sanni sannib@za.afro.who.int National Professional Officer - TUB WHO/South Africa WHO Staff Headquarters 61. Dr Katherine Floyd floydk@who.int Coordinator TB Monitoring & Evaluation team Stop TB Department 62. Dr Dennis Falzon falzond@who.int Scientist, Laboratories, Diagnostics and Drug-Resistance team Stop TB Department 63. Dr Philippe Glaziou glazioup@who.int Senior Epidemiologist TB Monitoring & Evaluation team Stop TB Department 64. Dr Irwin Law lawir@who.int Consultant TB Monitoring & Evaluation team Stop TB Department 65. Dr Ikushi Onozaki onozakii@who.int Team Leader, Prevalence Surveys TB Monitoring & Evaluation team Stop TB Department 66. Dr Charalampos Sismanidis sismanidisc@who.int Statistician TB Monitoring & Evaluation team Stop TB Department 67. Mr Hazim Timimi timimih@who.int Data Manager TB Monitoring & Evaluation team Stop TB Department 68. Dr Matteo Zignol zignolm@who.int Scientist TB Monitoring & Evaluation team Stop TB Department 16