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Some updated information from Consultation on Research for Tuberculosis Elimination, Karolinska Institutet, Stockholm, 24, 2014 A/Prof. Nguyen Viet Nhung, MD., PhD Director, National Lung Hospital Manager, National TB control Program Viet Nam NINTH TECHNICAL ADVISORY GROUP AND NATIONAL TB PROGRAMME MANAGERS MEETING FOR TB CONTROL IN THE WESTERN PACIFIC REGION Manila, Philippines, 9-12 December 2014

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Result of BREAKOUT DISCUSSION (GROUP 4) Liz Corbett Afranio Kritski Viet Nhung Nguyen Joseph Cavanaugh Nadia Khelef Ajaya M.V. Kumar Tom H.M. Ottenhoff Melvin K. Spigelman Alison Kraigsley Abdul Ghaffar Anna Scardigli Tom Evans Knut Lnnroth

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AspectGlobalCountry (LMIC) Curent situation - There are some models in several countries: Brazil, Viet Nam, India, Indonesia, - Multi-country academic networks - WHO Training package for TB control, but not yet for TB research training There are available TB research in all countries, but still: - Lack of information about Research (Capacity, HR, opportunity, ) - Lack of effective models for Capacity building - Lack of coordination of all existing, ongoing research in countries (projects, institution, researchers, resources) overlap, no translation into practice, waste - There are various level of TB research: R&R, data management, basic implementation research The needsThere are Roadmap and OR priority - Toolkit for evaluation: SWOT analysis - Guidance for create research demand for the new strategy - A new program, model for TB research training - TA for TB research - Mapping key institutions Country TB Research Agenda - SWOT analysis on Tb research - Prioritizing the gaps - Planning to fill the gaps - Mapping, inventory all available, ongoing project, HR, partners - True partnership for TB research - Coodination and ownership: MoH, NTP, MoEdu, - NTP needs to be the core Solutions - Guideline / recommendation - Framework for capacity building for TB Research - Model and piloting model - Identify the priority researches that should be focus of the country (basic implementation research) - Establish strategic plan of TB research in the national strategy for TB control as the whole (TB research agenda) - Create a leadership, partnership for implementing the plan for better coordination and collaboration DO BETTER AND DO MORE

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AspectGlobalCountry (LMIC) 1 yearEstablish a ad hoc WG & ToR based in WHO -Define needs for 1 year deliverables -Identify key players (TB Programme, TDR, Alliance, the Union, ) -Guide for conducting in-country mapping and situational analysis -Develop participatory workshop facilitator guides for NTP to support comprehensive research strategy generation -Share training and research materials -Repository for materials -Hold workshop for exchange of ideas and lessons learnt between key players in TB and broader research capacity building initiatives -Best practice country examples to share learning points and draw guidance -Encourage in-country mapping and situational analysis with needs assessment of TB activities and NTP capacity to conduct research in all countries -Develop clear plan for comprehensive National TB Research Agenda and capacity building strategy (inc OR, basic etc) -Example Research Strategy plans from key countries -Pathfinders -Viet Nam, Kenya, BRICS, Uganda, Malawi -Invite applications from all countries -Ask regional offices to nominate -In-country regulatory review to define functionalities, timelines and information for international collaborators -Initiate consideration of regional harmonization plans -Initiate consideration of regional research networking plans -Include critical assessment meetings in regional meetings and International Union Conferences EXPECTATION

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AspectGlobalCountry (LMIC) 5 years Researchers toolkit, databases, and data sharing Established global research movement with regional hubs Expansion of TB research network in regions and countries All high burden countries have a Strategic research and capacity building plan Regional networks established Individual and multicountry studies providing results OR funds available from Global Fund are fully utilized Funding sources diversified and increased, including in-country investment Supportive research environment and regulatory processes 10 years Researchers toolkit, databases, and data sharing Scale up TB research network in countries, regions and global to know how to achieve the TB control Goal. Capacity to evaluate TB epidemic and control interventions Established leadership in comprehensive TB research platform from (formerly) high burden countries Clear examples of contribution of national research to local control efforts

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Messages to region and countries 1.Adapt the Global research movement in regions with regional hubs 2.Establishment and expansion of TB research network in regions and countries 3.Countries should develop a Comprehensive TB Research Agenda integrated in the National Strategic Plan with appropriate research capacity building 4.Countries should be involved and responsible in all kind of research for TB Control

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PILLAR 3 POST 2015 NATIONAL STRATEGY FOR TB CONTROL PILLAR 3 Viet Nam an example

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Pillar 3 - an example: Viet Nam LevelFrameworkFunding resources Government / MoH National Strategy to 2020 with vision 2030: Optimize the application of current and new technologies, approaches in TB detection, diagnosis, treatment and prevention Govt National ProgramNational Strategic Plan for TB control 2015-2020 Objective 4 (of 4). To sustain and promote monitoring, evaluation and surveillance of the TB epidemic and control while applying new technologies and approaches in TB control by routine data, surveys and researches. - 16 projects in agenda 2015-2020 with Govt and partners GFATM, AUSAID, USAID, CDC, WHO, Projects, Partnership National Lung Hospital / NTP: Core partner TB and lung disease research coalition: MoH, MOST, Academy, University, Institution. International partners: KNCV, WHO, UCSF, Sydney University, WMRI, LSHTM, Provincial program and other institution -R&R, case based, web based surveillance system -Research Project implementation: capacity building on needs -Promoting younger researchers

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16 ITEMS IN THE AGENDA 2015 -2020 VTN NSP TB CONTROL 4.1. Further development and updating of both paper based and electronic R&R systems (VITIMES and e-TB manager) to support the program measure indicators for IC, Childhood TB, PPM, Community engagement, Pharmacovigilance and new drugs and regimens initiative, equipment maintenance etc. 4.2. Develop and implement data quality assurance and security system for protection of electronic records. 4.3. Identify new gaps from the feedback of M&E and supervision visits and strengthening health facilities to fulfil the needs for PPM and PMDT scale up. 4.4. Strengthen research partnership with universities in Vietnam 4.5. Analysis of population access to TB services per province and population groups 4.6. Enhanced surveillance for risk group identification and follow-up of yield attributable to active and passive case finding in each risk group 4.7. Operational research to underpin and support the stepwise introduction of new regimens for TB and/or MDR, including pharmacovigilance 4.8. Continuation of the STREAM trial in HCMC, ACT3 in Ca Mau (Community based genExpert screening for TB), TBTC in Ha Noi (clinical trials for TB drugs and regimens), GeneTB. 4.9. Operational research to support and evaluate new tools (mHealth, CAD4TB), in public and private sector 4.10. Studies on elimination of TB in Vietnam, modeling of the epidemic in collaboration with the London School of Hygiene & Tropical Medicine (LSHTM), piloting interventions in preparation of scenarios for TB elimination 4.11. National Prevalence survey of Tuberculosis (2015-2017) 4.12. 5 th National Drug Resistant Survey (2015-2016) 4.13. Studies related to health financing (Vietnam transitioning towards full coverage of health insurance, paying for TB diagnosis and treatment) 4.14. Study on fluoroquinolone and pyrazinamid resistance among new patients 4.15. Sentinel survey for TB in KAPs 4.16. Mortality and fatality of TB in sentinel areas

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Christian Lienhardt