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 meetingGeneva, 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, governsprojects; 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

Tec

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ical

Wo

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GLI Secretariat GLI Working Group

GLI Network

~100.000 smear lab centers200.000-300.000 personnel

~8.000 advanced diagnostic centers40.000 – 50.000 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, 2009 - 2013 (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

Logistics and supplies

Human Resources

(Guidelines

Technology transfer)

Infrastructure Quality Assurance

Linked referral systems and

reporting

• 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 2009Category 2: start in 2010Category 3: start in 2011

Recipient countries Recipient countries

2,036

31,227

94,443

115,929129,670

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

pa

tie

nts

2009 2010 2011 2012 2013

Project targets*

6

25

25

2727

Co

un

trie

s

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 diagnosedand provided with appropriate treatment

under international standards of care

Diagnostics

Drugs

Patient care