ANNUAL REPORT Green Light Committee (January December 2005) The Green Light Committee of the Stop TB Working Group on DOTS-Plus for Multidrug-Resistant Tuberculosis US Centers for Disease Control and Prevention, Harvard Medical School/Partners in Health, International Union Against Tuberculosis and Lung Disease, National Tuberculosis Programmes Estonia and Latvia, Medical Research Council of South Africa and the World Health Organization.
I N T R O D U C T I O N The Green Light Committee (GLC) is an independent group of experts in programmatic, scientific, and clinical aspects of drug-resistant tuberculosis that serves WHO in a technical advisory capacity. At present, it is composed of six institutions representing the South Africa Medical Research Council, the International Union against Tuberculosis and Lung Diseases, the National TB Programmes Estonia and Latvia, the US Centers for Disease Control and Prevention, the Partners in Health/Harvard Medical School and World Health Organization. The GLC was formally established in March 2000 under the Stop TB Working Group on DOTS-Plus for MDR-TB. Activities of the GLC in 2005. The GLC held six meetings in 2005: one meeting was held in person in Paris during the Union conference, and the rest were held via teleconference organized by the WHO HQ. The activities performed by the GLC in 2005 were related to the review of applications, evaluation visits and technical assistance to DOTS-Plus pilot projects, planning for assistance to WHO on policy-making of MDR-TB management, preparation of the new guidelines and GLC application instructions. Review of Applications. In 2005, the GLC reviewed and approved 12 applications: 4 applications for cohort expansion (Abkhazia, Bolivia, Costa Rica, Romania); and 8 new applications (Egypt, Moldova, Tunisia, LRS Institute - India, Dominican Republic, Azerbaijan, Timor-Leste, Lithuania) (see Table 1). Table 1. Projects approved by GLC in 2005. 2005 12 cohorts -- year total-- patients 2081 1 half 5 cohorts -- 6 months total -- patients 555 10-Jan-05 EGY Egypt approved 75 28-Feb-05 MOL Moldova approved 190 09-Mar-05 TUN Tunisia approved 65 06-Apr-05 IND/LRS IND/LRS approved 100 11-Apr-05 DOM Dominican approved 125 2 half 7 cohorts -- 6 months total -- patients 1526 05-Aug-05 AZE Azerbaijan approved 100 14-Nov-05 ABK/MSF/2 Abkhazia approved 126 14-Nov-05 TIM Timor-Leste approved 18 15-Nov-05 BOL/2 Bolivia approved 100 15-Nov-05 COS/2 Costa Rica approved 10 15-Nov-05 LIT Lithuania approved 972 15-Nov-05 ROM/GF/2 Romania approved 200 Overall, starting March 2000 until December 2005, the GLC has received and reviewed 60 applications from 51 project sites in 36 countries and approved 33 DOTS-Plus projects (not
counting expansions). Throughout the whole period 2 applications have been withdrawn (CTRI in Moscow, Russian Federation, and Nigeria Teaching Medical Hospital in Enugu, Nigeria); and two projects have been cancelled by the local authorities before starting (Kemerovo - Russian Federation and Malawi). 9 projects applied for cohort expansions and all of those applications were approved. A total of 12'430 MDR-TB patients were approved for enrolment in these projects (excluding those withdrawn). Table 2. GLC approved projects 2000-2005. Year Project name Number of patients 2000 Philippines 200 Peru 800 2001 Orel (Russian Federation) 200 Latvia 350 Estonia 200 Tomsk (Russian Federation) 630 2002 Peru (expansion) 800 2003 Mexico 125 Uzbekistan (MSF) 100 Arkhangelsk (Russian Federation) 890 Costa Rica 14 Bolivia 10 Haiti 60 Peru (expansion) 2000 Ivanovo (Russian Federation) 200 2004 Nepal 350 Honduras 50 Lebanon 20 Philippines (expansion) 750 El Salvador 57 Estonia (expansion) 200 Nicaragua 21 Kenya 40 Kyrgyzstan 50 Abkhazia 30 Syria 161 Uzbekistan (MSF, expansion) 846 Tomsk (expansion) 900 Jordan 45 Georgia (prisons) 50 Romania 200 2005 Egypt 75 Moldova 190 Tunisia 65 LRS Institute -India 100 Dominican Republic 125 Azerbaijan 100 Abkhazia (expansion) 126 Timor-Leste 18 Bolivia (expansion) 100 Costa Rica (expansion) 10 Lithuania 972 Romania (expansion) 200 TOTAL 12,430
Monitoring Visits to GLC approved projects. 17 projects in 14 countries were monitored and provided with technical assistance. As a practical part of training following MDR-TB consultants course in Riga, Latvia, 6 consultants-in-training participated in the field missions of GLC. Table 3. GLC monitoring visits to DOTS-Plus pilot projects in 2005. Project GLC Consultant Consultant-in-training Dates Mexico AMRO Ernesto Jaramillo Kayla Laserson (CDC) Raimond Armengol (PAHO) Honduras AMRO Jose Caminero Raimond Armengol (PAHO) Peru AMRO Ernesto Matteo Zignol (WHO HQ), Jaramillo Nicaragua AMRO Jose Caminero El Salvador AMRO Jose Caminero Costa Rica AMRO Jennifer Furin (PIH), Felix Alcantara Paraguay AMRO Raimond Armengol (PAHO) Ecuador AMRO Jose Ramon Cruz Dominican AMRO Jose Republic Caminero Uzbekistan EURO Vaira Leimane G. Tsogt (WHO Central Asia), Agnes Gebhart (KNCV), Pierpaolo de Colombani (EURO) Abkhazia (Georgia) EURO Kai Vink (KNCV); Fuad Mirzayev Orel (Russian Federation) EURO Vaira Leimane Archangelsk EURO Manfred (Russian Danilovits Federation) (Estonia) Romania EURO Peter Cegielski Ivanovo EURO Joia Mukherjee Georgia EURO Kai Vink (KNCV), Fuad Mirzayev Tomsk (Russian Federation) EURO Kai Vink (KNCV) week of 8 August September 28-29 September April, 2005 April, 2005 March, 2005 July, 2005 July, 2005 October 5-6 28 Nov-3 Dec 28 Nov-2 Dec 26-30 September 19-23 September Zachary Taylor (CDC) 26-30 September Feb, 2005 28 February-4 March 2005 December 12-16 Collaboration with the Global Fund to Fight against AIDS, Tuberculosis and Malaria After 5 rounds of applications the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) has approved funding for establishment and running projects to control drug-resistant TB in 29 countries with 9 proposals approved in the 5 th round. The GLC has assisted and approved one or several projects 18 countries. Table 4 summarizes collaboration between GLC and GFATM.
Region Country* Round Approved by the GLC GLC Technical assistance Comments AFR DRC 5 Application in process AFR Namibia 5 AFR Kenya 5 X Application approved by the GLC, project waiting for GF disbursement to start. AMR Bolivia 3 X X AMR Dominican Republic 3 X X AMR El Salvador 2 X X AMR Ecuador 4 X Application in process AMR Honduras 1 X X AMR Nicaragua 2 X X AMR Paraguay 3 Application in process AMR Peru 2 X X 5 X EMR Egypt 2 X X EMR Jordan 5 X X EUR Georgia 4 X to start in 2007 EUR Romania 2 X X EUR Russian Federation 4 X X EUR Moldova 1 X X EUR Kyrgyzstan 2 X X EUR Serbia- Montenegro EUR Uzbekistan 4 X EUR Armenia 5 Project in Tomsk; several projects using various funding sources. More projects to start in 2006 3 to start in 2008 MSF funded project in Nukus. Both in Nukus and Tashkent - 2006-2009; 110-170-170-170 (pts) MSF started a pilot but not yet applied to the GLC EUR Azerbaijan 5 X X starts in 2006 SEAR India 4 SEAR Nepal 4 X X SEAR Bangladesh 5 X to start in 2006 SEAR Indonesia 5 to start in 2007 WPR Mongolia 4 X X 2 X X WPR Philippines 5 WPR China 5 to start in 2006 * proposals approved in round 5 are on white background Change in the membership Dr Michael Rich replaced Dr Joia Mukherjee as a principal member representing Partners in Health (Harvard Medical School). Dr Salmaan Keshavjee was nominated as an alternate for the PIH. Both changes were approved by the GLC.
Annex 1: Institutions and Institutional Representatives for the GLC by the end of 2005 1) Dr Ernesto Jaramillo World Health Organization 20 Avenue Appia CH-1211 Geneva Switzerland Tel: 41-22-791-3034 Fax: 41-22-791-4268 email: jaramilloe@who.int Alternate: Ms Eva Nathanson Email: nathansone@who.int 2) Dr Peter Cegielski (chairman of the GLC) Centers for Disease Control and Prevention CDC, Mailstop E-10 1600 Clifton Rd. Atlanta, GA 30333 USA Tel: 404-639-8120 Fax: 404-639-8604 e-mail: gzc2@cdc.gov Alternate: Dr Charles Nolan Email: charles.nolan@metrokc.gov 3) Dr Joia Mukherjee (member till October 2005) Harvard Medical School Program in Infectious Disease & Social Change Department of Social Medicine 641 Huntington Avenue Boston, MA 02115 USA Tel: 617-432-3715 Fax: 617-432-2565 E-mail: jmukher@attglobal.net Dr Michael Rich (principal member since October 2005) Partners in Health Email: mrich@attglobal.net Alternate: Dr Salmaan Keshavjee (since October 2005) Email: Salmaan@pih.org 4) Dr Vaira Leimane Programme Director Training Centre of the State Centre of Tuberculosis and Lung Diseases of Latvia P/o Cekule, Riga Region LV-2118 Latvia 7
E-mail: Vaira.Leimane@tuberculosis.lv Alternate: Dr Vahur Hollo E-mail: vahur.hollo@regionaalhaigla.ee 5) Dr Karin Weyer Medical Research Council South Africa Tel: Fax: E-mail: karin.weyer@mrc.ac.za Alternate: Martie van der Walt Email: martie.van.der.walt@mrc.ac.za 6) Dr Jose A Caminero International Union Against Tuberculosis and Lung Disease (IUATLD) 68 boulevard Saint-Michel, 75006-Paris, France Tel: +33 1 44 32 03 62 - Fax: +33 1 43 29 90 87 E-mail: jcamlun@gobiernodecanarias.org Alternate: Dr Arnaud Trebucq Email: trebucqa@iuatld.org 7) Dr Fuad Mirzayev (WHO GLC Secretariat) World Health Organisation 20 Avenue Appia CH-1211 Geneva Switzerland Tel: 41-22-791-1809 Fax: 41-22-791-1589 email: mirzayevf@who.int 8