The Global Laboratory Initiative Assisting countries to implement the WHA resolution on MDR-TB Karin Weyer, WHO-STB, GLI secretariat John Ridderhof, CDC, GLI chair TB/HIV Core Group meeting Geneva, November 3-4, 2009

Global Laboratory Initiative Platform of coordination and communication, providing the required infrastructure, focused on TB laboratory strengthening, in the areas of: Global policy guidance (norms, standards, best practices) Laboratory capacity development Interface with other laboratory networks, enabling integration Standardised laboratory quality assurance Coordination of technical assistance Effective knowledge sharing Advocacy and resource mobilisation

GLI structure & governance GLI Secretariat GLI Partners Committee GLI Core Group Stop TB Partnership Laboratory strengthening roadmap Human resource development strategy Laboratory biosafety Laboratory accreditation Other Evaluates, approves, governs projects; Advises GLI Secretariat Advises and approves strategic agenda of GLI; Monitors project progress WHO Stop TB Department Priority projects and activities Time limited Partner approach Technical Working Groups GLI Secretariat GLI Working Group

GLI Network ~ smear lab centers personnel ~8.000 advanced diagnostic centers – personnel 28 SRLs supporting 150 NRLs >70 GLI Members WHO GLI Office Knowledge sharing -Coordinating TA, training -Communication technologies - Online knowledge resource network Interface connection -Matchmaking projects between countries and implementing partners -National “roadmaps” -Advocacy -Other disease networks Assurance activities - Coordination of EQA -Equipment specifications -Global accreditation system -Monitoring/evaluation Guidance -Laboratory policies -Laboratory manuals -Training materials -Resource mobilization -National roadmap advice Key GLI activities Capacity building (expanding SRLN, building diverse and flexible national, regional, international consultants base, systematic and structured training) 7 STP WGs Technical Agencies Other Laboratory Networks Other Diseases

GLI strategic priorities Accelerating evidence-based policy development on diagnostics and laboratory practices Promoting a structured framework/roadmap for TB laboratory strengthening within the context of national laboratory plans at country level Developing a comprehensive set of tools, norms and standards based on international standards and best- practice Advancing laboratory strengthening through global, regional and local partnerships Developing multi-level laboratory human resource strategies to address the capacity crisis Accelerating new diagnostics into countries

Accelerated uptake of new MDR-TB diagnostics in 27 countries, (additional 15 planned by 2012) State-of the-art commodities (instruments, tests, reagents) funded by UNITAID Leverage other local partners to address non-commodity components (infrastructure, training, etc.) Long-term mentoring and TA: in-country hands-on support to optimise technology and knowledge transfer, closely linked to capacity building Full ownership of MOH, NTP, Laboratory Integrated laboratory approach (notably TB and HIV) Adjustment based on growing evidence ('learning by doing')

Policies, norms international standards Participate in lab assessments Provide long-term, on-site monitoring Develop indicators and tools for M&E Funding for essential instruments, reagents, supplies Negotiate with partners to ensure lowest prices Ensure customer support in place Share know-how from product development process Provide long-term, on-site mentoring for technology transfer Coordinate and manage procurement and delivery With FIND, engage industry to ensure affordability and sustained price decreases Collaborate with WHO Pre-qualification to include diagnostics

8 Category 1: start in 2009 Category 2: start in 2010 Category 3: start in 2011 Recipient countries

Countries Total * Targets calculated as a % of estimated MDR-TB burden: 80% for most countries; 35% for India and 60% for Zambia and Cameroon

Country partners American Society for Microbiology Centers for Disease Control and Prevention Johns Hopkins University GHESKIO Global AIDS Programme GTZ KfW Bank, Germany KNCV Ministeries of Health, through NTPs Partners in Health PEPFAR OGAC Project Hope ICRC The Global Fund The Union USAID WHO Supranational Reference Laboratory Network …

Future scale-up EXPAND-TB –15 additional countries by 2012 Other low-income, high-endemic countries –Adoption of EXPAND-TB model with other funding sources and other laboratory initiatives (eg. HIV, Malaria, H1N1) Middle-income, high-endemic countries –Two-pronged approach (manufacturers and laboratory networks) in innovative PPM models Acceleration of GLI human resource development plan –At least 50 global consultants –At least 50 long-term, on-site mentors –Up to 20,000 laboratory technicians with advance skills –MOH responsibilities in revised human resource plans & strategies

Global targets met for MDR-TB patients diagnosed and provided with appropriate treatment under international standards of care Diagnostics Drugs Patient care