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2. European network for study and clinical management of TB drug resistance. An integrated approach for controlling MDR-TB spread in Europe Daniela M Cirillo WHO CC for integrated laboratory strengthening on Tb and other emerging infections San Raffaele Scientific Institute, Milan Italy

3. Overview  European consortium with extensive experience in basic and clinical research relating to MDR-TB, TB diagnosis, control and epidemiology.  Network of 18 European Countries, 27 beneficiary Institutions, organized in 8 Work Packages (WP) dedicated to scientific research and project management.  Duration 5 yrs (2009-2013).  The main objective of the proposal is to establish an integrated and synergistic network to address the challenge of drug resistant TB facing the EU.  Complementary to activities supported by International Agencies

4. Partner Nr. 27: University of Medicine and Dentistry of New Jersey – USA Italy: 5 United Kingdom Germany: 2 Switzerland: 2 France Lithuania: 2 Romania: 2 Sweden Denmark Croatia Slovenia Latvia Estonia Norway Belgium Finland Poland 27 PARTNERS Samara Oblast, Russian Federation (subcontractor)

5. TB PAN-NET Objectives – 1 Main objective: Establish an integrated and synergistic network to address the challenge of drug-resistant TB facing the EU. Implementation: Extensive and focused programme of basic and clinical research to improve the diagnosis and clinical management of MDR-TB Improve our understanding of MDR-TB transmission at molecular level and host-related risk factors for its development Extensive data collection on risk factors and treatment outcomes of MDR-TB patients from different parts of Europe, to determine risk factors responsible for MDR-TB development and to define the success of different treatment regimen on the clinical outcome in relation to the level of drug-resistance

6. TB PAN-NET Objectives – 2 Implementation: Create a series of field sites across the EU with the capacity for evaluating new diagnostic systems and novel drug therapies on behalf of European industry and government. Establish a unified and robust QA mechanism for the accurate and rapid diagnosis of DR and develop appropriate safety standard for European workers involved in the diagnosis and management of MDR-TB Develop a broad training curriculum for the creation of a new generation of microbiologists, molecular biologists and clinicians expert in DR-TB management Disseminate findings and analyses to the benefit of specialists, general health care staff, EU governments, non governmental organizations (NGOs) and health policy makers.

7. Cooperations in TB PAN-NET Molecular epidemiology of MDR-TB in Europe SMEs for new diagnostics ECDC projects Development and dissemination of Training packages in full agreement with WHO and ECDC guidelines Dissemination and information on MDR-TB at European Level Scientific Associations

8. Main achievements up to dates Molecular typing platform and data base Diagnostics for MDR TB: –Data on heteroresistance –New mutations leading to drug resistance –Therapy monitoring by molecular methods –Large diagnostics and biomarkers trials –New approach to EQA for conventional DST Prospectic data base on MDR-TB patients and follow up data