TUBERCULOSIS: STOP TB NEWS

January 2013

TOP LINE NEWS

Help make TB a global priority after 2015

The Stop TB Partnership encourages partners and friends to vote in two influential global surveys on the post-2015 development agenda.

Update from the Global Drug Facility

Kicking off the new year, GDF has secured lower prices for second-line drugs and is now offering microscopes with LED fluorescence.

Cochrane Library review shows Xpert to be highly accurate

A review published in The Cochrane Library, which assesses the diagnostic accuracy of the Xpert test, has found it can accurately and quickly detect TB.

Stop TB Partnership welcomes focus on TB by BRICS health ministers in Delhi Communiqué

Ministers of Health place focus on TB, including multidrug-resistant TB and TB/HIV, as major health threats in need of urgent attention.

TB Alliance receives grant from UNITAID to develop pediatric TB drugs

UNITAID has provided TB Alliance with a three-year grant to accelerate the development of pediatric TB regimens.

Union project shows how low-income countries can deliver integrated TB/HIV care

Partners have reported results from operational research projects in Benin, the Democratic Republic of Congo and Zimbabwe.

United States Government announces $11 million in additional support for rapid TB test in 14 countries

The United States President’s Emergency Plan for AIDS Relief has announced US $11 million to provide Xpert MTB/RIF instruments and test cartridges.

TB PEOPLE

BD’s Gary Cohen to serve as chief executive for GBC Health and MDG Health Alliance

Gary Cohen, Executive Vice President of Becton, Dickinson and Company has been appointed CEO of the MDG Health Alliance and acting CEO of GBC Health.

Jordan’s national TB champion inspires donations to flood-hit Syrian refugee camp

The Omani embassy in Jordan has teamed up with TB Champion Rania Ismail to provide support to Syrian refugees at the Zaatari camp in northern Jordan.

Global leaders in Davos put spotlight on TB in Afghanistan

An event organized by Global Health and Diplomacy and Roll Back Malaria focused on TB as a major health and development challenge for Afghanistan

Sue Etkind appointed as Executive Director of Stop TB USA

Former Director of TB Prevention and Control for the Massachusetts Department of Public Health succeeds John Seggerson as Executive Director.

Jim Connolly steps down as President and CEO of Aeras

Chief Scientific Officer Dr Tom Evans will serve as interim CEO while Aeras’s Board of Directors selects a permanent successor.

Video interviews from TB’s front lines

Advocate David Bryden interviews doctors and nurses who are working to stop TB and, in some cases, have become ill with the disease themselves.

The Union elects new board members

The International Union Against Tuberculosis and Lung Disease has elected four new members to serve on its board of directors.

KNCV staff win Nigerian award

KNCV Tuberculosis Foundation's Emmy van der Grinten and Gidado Mustapha have received Gold Awards from Nigeria’s national TB and leprosy programme.

NEWS FROM OUR PARTNERS

 

Opinion: No one wants to be a TB suspect

Danielle Doughman from ACTION argues that we can learn a lot from the disability community about using more inclusive language.

Implementers gather to assess effectiveness of new TB diagnostics

The meeting provided a forum to share data, conclusions and research models from studies being carried out in countries on the Xpert diagnostic.

Rinat Akhmetov Foundation launches new TB information campaign

The Development of Ukraine foundation has launched the second wave of an information campaign that aims to reduce TB-associated stigma.

Azerbaijan shares best practice on TB in prisons

The Main Medical Department of the Azerbaijani Ministry of Justice hosted a series of visits in 2012 aimed at sharing best practice on TB care in prisons.

ImmBio enters into co-development agreement with China for TB vaccine

Vaccine developer ImmBio has entered into a research, co-development and license arrangement with the Lanzhou Institute of Biological Products.

Winners of Viet Nam’s national painting and poster contests announced

Viet Nam’s National TB Programme, in collaboration with PATH, has announced the winners of two national painting contests for children and artists.

New funding for two vaccine candidates

The vaccine candidates MTBVAC and HBHA have been awarded financial support for further development. 

BEMFAM training programme boosts Brazil’s fight against TB/HIV

The Attention project of BEMFAM Family Welfare in Brazil has come to completion, having achieved the training of more than 1300 health professionals.

Former patients help PASADA carry out TB/HIV activities

PASADA, an NGO working with communities affected by HIV/AIDS, has recruited a number of former patients to help provide TB/HIV services.

ANNOUNCEMENTS

Global Green Light Committee seeks two new members

The World Health Organization and the Stop TB Partnership are recruiting two new members to serve on the Global Green Light Committee.

TBVI opens call for applications for vaccine evaluations

The Tuberculosis Vaccine Initiative has opened a call for applications from organizations wishing to test vaccine candidates.

Deadline for Indian journalism award approaches

The deadline for submissions to the REACH-Lilly MDR-TB Partnership Media Awards is Friday 2 February.

PUBLICATIONS

Drug-resistant TB drugs under the microscope: second edition now available

The Union and Médecins sans Frontières have published a second edition of the guide DR-TB drugs under the microscope: sources and prices of medicines.

Review suggests that more operational research would support scale-up of TB interventions

Review in PLOS Medicine concludes that rigorous operational research would support the implementation of WHO-recommended TB interventions.

WHO publishes tuberculosis laboratory safety manual

New manual is aimed at directors and managers of laboratories and TB programmes as well as laboratory technicians who test for TB.

Two new publications on Xpert by WHO authors

Articles in the European Respiratory Journal cover the cost and affordability of Xpert and evidence, policy making and global implementation.

CORE Group handbook shows how civil society organizations can contribute to the fight against TB

The CORE Group has published a handbook for nongovernmental organizations and civil society organizations that are considering joining the fight against TB.

TUBERCULOSIS: Cochrane Library review shows Xpert to be highly accurate

From:	MANDELBAUM-SCHMID, Judith Ann
Date:	Thu, Jan 31, 2013 3:45 am

A new systematic review published in The Cochrane Library, which assesses the diagnostic accuracy of the Xpert® MTB/RIF test, has found it can accurately and quickly detect TB. The Xpert test, which is endorsed by the World Health Organization (WHO), simultaneously detects TB and resistance to rifampicin, as an indicator of multidrug resistance. The test takes around two hours, with minimal hands-on technical time required.

Like sputum smear microscopy, which relies on detecting TB with a microscope in a laboratory, Xpert requires a sample of sputum. However, while thousands of bacteria must be present in each millilitre of sample for TB to be detected under the microscope, Xpert can detect TB bacteria at much lower concentrations. In addition, the conventional microscopy approach does not detect drug resistance. Instead, TB has to be grown in the lab. This presents problems, especially for multidrug-resistant TB, due both to the length of time required for the cultures to grow and the specialized laboratories and highly skilled staff needed.

The researchers, from the Cochrane Infectious Diseases Group, McGill University and the Foundation for Innovative New Diagnostics (FIND), analysed data from 18 studies involving a total of 7816 people, with most studies being carried out in low- and middle-income countries. The results show that when Xpert is used to screen 1,000 people, 150 of whom have TB, it picks up 132 of the 150 cases (88%) and falsely diagnoses 17 (2%) with TB. This is in a scenario where it is being used as a replacement for smear microscopy. In a scenario where Xpert is being used as a replacement for culture-based drug susceptibility testing, it is also able to detect the equivalent of 141 out of 150 cases (94%) of rifampicin resistance. When Xpert is used as a follow-on test, after conventional smear microscopy has already produced a negative result, it picks up 101 out of 150 cases (67%). By definition, smear-negative TB is not picked up by smear microscopy because microscopy cannot detect small numbers of bacteria. Xpert picked up 67% of this group that would have been missed by microscopy.

“This study represents the most comprehensive review on the diagnostic accuracy of Xpert to date and may help countries make decisions about scaling up its use for management of TB and drug-resistant TB,” said lead researcher, Karen Steingart, of the Cochrane Infectious Diseases Group.

Karin Weyer, Coordinator, Laboratories, Diagnostics and Drug Resistance in WHO’s Stop TB Department, noted that the review provides high quality evidence that reinforces WHO’s endorsement of this test. ”Recent price reductions have greatly facilitated roll-out of this technology, including a new three-year initiative called the TB Xpert Project, funded by UNITAID and executed by WHO and the Stop TB Partnership. 1.4 million test cartridges and over 200 GeneXpert instruments for the rapid detection of TB and rifampicin resistance will be distributed in 21 countries with a high burden of TB,” she said.

Welcoming the Cochrane Review of Xpert, Lucica Ditiu, Executive Secretary of the Stop TB Partnership, said: “This innovative device represents a major milestone in the quest to achieve the goal of zero deaths from TB – which is curable but still takes the life of three people every minute. The Stop TB Partnership is making every effort to help countries understand how best to use this new technology. Our TB REACH initiative is deploying Xpert to numerous countries through projects that seek to increase the number of TB cases detected and treated, and these projects will deliver data that can provide an evidence base for determining how Xpert should be used for the greatest impact.”

URL Upon publication: http://doi.wiley.com/10.1002/14651858.CD009593.pub2

POVERTY: Bangladesh: Needs assessment fatigue

Photo: Contributor/IRIN

Bangladesh is one of the most disaster-prone countries in the world

DHAKA, 31 January 2013 (IRIN) - Donors and the Bangladeshi authorities have welcomed the recent implementation of the joint needs assessment (JNA) approach  to better serve disaster-affected communities and reduce the harassment of survivors by multiple aid agency assessors.

“The JNA approach is a welcome development,” Sarah Cooke, country representative of the UK’s Department for International Development, told IRIN in Dhaka. “It will provide a unified, evidence-based assessment of needs that will help donors, NGOs and the government of Bangladesh to work together and begin quickly to channel the right assistance to where it is needed most.”

“In a nutshell, the JNA will help the government to take decisions in regard to an emergency response quickly,” said Abdul Latif Khan, a specialist with the government’s Comprehensive Disaster Management Programme.

Under JNA, aid workers from various agencies team up with local government officials to assess humanitarian needs across different sectors (shelter, health, food, water and sanitation) to produce a single assessment as opposed to multiple assessments by multiple agencies.

“JNA will give voice to affected communities and emphasize the accountability of the agencies involved in disaster response,” said Harun or Rashid, programme manager of the Emergency Capacity Building Project (a consortium of six international NGOs working to improve the speed, quality and effectiveness of humanitarian communities in emergencies).

Multiple assessments

JNA comes in the wake of uncoordinated rapid needs assessments by agencies in Bangladesh, often resulting in duplication of effort, assessment fatigue among affected communities, and potentially conflicting data sets.

First tested in August 2011, JNA was formally adopted and endorsed by the government in May 2012, before being put into practice in June following heavy flooding in the north and southeast of the country.

Some 47 agencies participated in the JNA, which took place in close collaboration with the government, and utilized information provided by local authorities. The time from the decision to launch the assessment, until findings were presented, was three days; the findings were used by the authorities as part of their response.

Why it matters

According to the Asian Disaster Preparedness Center, Bangladesh is ranked one of the most disaster-prone countries in the world, with cyclones striking coastal regions almost every year.

More than two-thirds of districts are prone to natural disasters, including cyclones, floods, landslides, tornadoes and drought.

Photo: David Swanson/IRIN

The JNA will allow assistance to get in faster

In the past, humanitarian agencies would routinely undertake their own field assessments; either on their own or in conjunction with one of their partners - and these assessments would also form the basis for financial requests to donors.

But unilaterally undertaking assessments in a country with one of the largest humanitarian communities in the world creates problems, and places an additional burden on affected communities.

In addition to 12 UN agencies in the country (five of which are directly involved in humanitarian assistance and have an emergency response capacity), there are more than 75 international NGOs, 30 of which respond to natural disasters when needed. There are also more than 2,000 officially registered local NGOs, as well as over 60,000 community-based organizations.

“The problem with this approach was that too many agencies were producing too many reports with too many intentions which were misleading to donors and overlooking peoples’ multifaceted needs after a disaster,” Kaiser Rejve, the humanitarian programme manager of Oxfam in Bangladesh, explained.

In the wake of heavy waterlogging in Bangladesh’s southwestern coastal district of Satkhira in 2010, donors received no fewer than 14 different assessments of the needs of affected communities.

Burden on survivors

“After Cyclone Aila in 2009, almost each day we saw a different team from a different agency coming and asking the same survivors what they needed,” said Ashek-E-Elahi, general secretary of the Peoples Research on Grassroots Ownership & Traditional Initiative, a civil society group working in Satkhira.

“This was a disgrace… Why is it necessary for different agencies to ask survivors - many of whom lost their homes, families and livelihood - the same question over and over again?” he asked.

Under the new system, the JNA report is shared with the Humanitarian Coordination Task Team, a joint platform formed by humanitarians to strengthen coordination.

“This approach proves that humanitarian agencies can work in a coordinated fashion despite their different mandates,” said Gerson Brandao, humanitarian affairs adviser to the office of the UN resident coordinator. He called the JNA one of the biggest achievements of the humanitarian community in Bangladesh to date

POVERTY: Malawi: More ethanol could lighten Malawi's fuel bill

Photo: Mujahid Safodien/IRIN

More sugarcane to save money on fuel imports

JOHANNESBURG, 25 January 2013 (IRIN) - As fuel prices climb in Malawi, amid fuel shortages and a soaring inflation rate - prompted by a 50 percent devaluation of the currency - a new paper suggests a way to decrease the country's reliance on imported fuel: biofuels.

Malawi is “the only African country that has consistently used liquid biofuels for transport for an extended period - since 1982”, points out the paper, which was jointly authored by economist Charles Jumbe, of the Centre for Agricultural Research and Development in Malawi, and Francis Johnson, a senior researcher at the Stockholm Environment Institute.

Fuel shortages and rising prices recently led to protests in Malawi, one of the world's poorest countries. Malawi spends US$33 million a month importing fuel, according to a December 2012 report in Engineering News, which said the government had approved the use of ethanol as an alternative fuel for motor vehicles.

Ethanol and vegetable oil 

Motorists in Malawi already use a blend of the conventional fossil fuel and ethanol produced from molasses - the by-product of producing sugar from sugarcane. The strategy was adopted in the 1980s to save foreign exchange.

The country launched a five -year project to consider the option of running vehicles exclusively on ethanol in 2007. 

But Malawi has not been producing sufficient quantities of ethanol. 

The amount of ethanol being produced has dropped over the years, as it relies on a poor-quality molasses that is produced seasonally, Jumbe explained via email. The ethanol production plants are currently operating at half their capacity. This has affected the amount of ethanol being blended with the fossil fuel, forcing a greater dependency on the imported fuel. 

If the production of sugar is expanded, ethanol production could ease some of the country's foreign exchange burden, he said. 

"The high commercial value of sugar and ethanol has brought considerable socioeconomic benefits to both small farmers and estate workers [in Malawi]," notes the paper. 

"Even where electricity is near households, the cost of electricity connection is very high. As such, even those with electricity in urban areas rely on firewood and charcoal for cooking. Most households use electricity mainly for lighting"

"Blending of straight vegetable oil (SVO) with diesel and with paraffin is now also under way in Malawi," it says. 

The vegetable oil is locally produced by some 25,000 small farmers from the Jatropha curcas plant, which is grown in hedgerows around their farms. 

But agriculture in Malawi is in trouble, affected by increasing variability in rains and temperatures. 

Protecting forest 

The paper looks not only at Malawi's energy needs but also at the transitions taking place in its energy consumption, which is endangering the country's forests. 

Forest cover is depleting at a rapid rate, as firewood and charcoal made from wood account for 88 percent of total energy and 98 percent of household energy use. In the 1960s, more than half of Malawi’s land area was covered by forest, the paper says. The number has dropped to 34 percent, according to a 2010 UN Food and Agriculture Organization estimate. 

Jumbe and Johnson note that while rapid urbanization seems to have weaned a substantial number of Malawians off firewood, it has pushed them towards charcoal use, as electricity remains expensive and out-of bounds for most people. 

"Not all households are near the electricity grid system," said Jumbe. "Even where electricity is near households, the cost of electricity connection is very high. As such, even those with electricity in urban areas rely on firewood and charcoal for cooking. Most households use electricity mainly for lighting. The number of bicycles that trek to urban cities with bags of charcoal in the big cities of Blantyre and Lilongwe is testimony to this!" 

Malawi must consider making electricity accessible and cheaper for its people as a priority, he added

POVERTY: DRC: small steps to land reform in eastern DRC

Photo: Nicholas Long/IRIN

Impassable roads - another obstacle to viable livelihoods

KINSATI, 29 January 2013 (IRIN) - Shukuru Rudahunga keeps a wary eye on the steep slope above her as she weeds her patch of sorghum in the eastern province of North Kivu, in the Democratic Republic of Congo (DRC); she knows the risks are deadly. 

Landslides have killed several people in nearby Kinsati, 40km from the city of Goma. 

"If it's been raining and I see the earth breaking up, I stop working and get off the hillside," she told IRIN. 

Erosion also washes away seeds, plants and soil fertility. Villagers know that to protect against soil loss, they should fallow the steeper slopes after just a few seasons. 

But “we don't do it because there isn’t enough land", Shukuru said. 

The over-cultivation has also resulted in plummeting yields. Teacher Gabriel Hanyurwa remembers that, in the 1980s, farmers harvested 20 sacks of beans per hectare on land that now yields only six to eight sacks. 

The land shortage results in part from population growth and in part from the expansion of cattle ranches. 

"Since the ranchers brought their cattle here, we haven't had enough fields," Hanyurwa said. 

"The ranchers prefer to put their cattle in the same places that we want to cultivate," another villager, Therese Tusali, said. 

In a 2010 paper, ‘Land, Power and Identity: Roots of violent conflict in Eastern DRC’, author Chris Huggins noted that recent decades have seen “massive alienation of land held under custom” in the Kivus in favour of cattle ranchers.

Residents in Kinsati and elsewhere have had little say in this process. 

Driving conflict 

Land disputes are key drivers of conflict in eastern DRC, and they hinder development across the country. Some researchers argue that agrarian conflict, rooted in issues of land rights and citizenship, is the principal cause of the Kivu region's wars. 

Population density, colonization and large-scale migration from Rwanda have all made access to land a critical issue in North and South Kivu. A corrupt judiciary and a flawed land law compound the problem. 

In his 2007 book, From Genocide to Continental War, Gerard Prunier describes the extent of “land grabbing” during the presidency of Mobutu Sese Seko as “incredible”, citing the attempt by one businessman in 1980 to take control of 230,000 hectares; the average land holding was less than one hectare. 

Land grabs, particularly from displaced communities, have continued amid the wars of the past two decades, and the prospect of an eventual land commission that might investigate these transfers has been a “sustaining factor in conflict”, Huggins has argued. 

Mediation initiatives 

Through their work resettling displaced communities, aid agencies have become involved in mediating land disputes. UN Habitat runs the largest of these programmes. In 2012, its three mediation centres in the region identified 1,690 land conflicts and resolved 641 of them. 

A conference in Belgium in September 2012 reviewed donors’ interventions in eastern DRC’s land problems; most of the spending had been on mediation. Koen Vlassenroot, who convened the meeting, says it was agreed that “mediation only seems to have an impact on conflicts between individual farmers; once larger players such as big landowners or army commanders are involved it’s very, very difficult”. 

Photo: Nicholas Long/IRIN

A conference held in Goma in 2012 on the new agricultural law

Conference participants were also concerned that mediation projects had “an acute lack of coherence, coordination”, and sustainability. 

Vlassenroot noted that there are two other main interventions to help resolve land issues: assisting the registration of land claims - which has had “limited results” and involves “all sorts of problems” - and locally driven efforts by farmers’ organizations to work on a land reform process. 

A report by International Alert highlights local efforts by the Forum of the Friends of the Earth (FAT) and the Federation of Congolese Agricultural Producers’ Organizations (FOPAC), whose success in lobbying for the integration of key issues in the new agricultural code offers “a grounded approach to peace-building”. These interventions have had much less support from donors. 

Lobbying by FAT and FOPAC led to the inclusion in the agricultural code of a provision for the mediation of land disputes, as well provisions for identifying and reallocating unused concessions and greater representation of “peasants”, or agricultural workers, in local decision-making. However, the government has yet to agree on implementation measures for the new law. 

Peasants take on land law 

These organizations are currently advocating reform of the land law, which fails to define customary land rights. Chiefs were legally stripped of their traditional land allocation powers in 1975, but many continue to exercise them. 

FAT and FOPAC have held consultations with farmers’ organizations in several provinces, including a forum in Goma, North Kivu Province, in October 2012. At the forum, many recommendations were put forward for improving the land law, such as ending land registry officials’ immunity from prosecution for “mistakes”, publicizing details of unjust land transfers and revealing the ownership of unused land concessions. 

But none of these politically sensitive recommendations figured in the FOPAC newsletter, which recorded only that participants had called for customary chiefs to respect their predecessors’ land allocations, for taxes on title deeds to be reduced and for tenancy documents issued by chiefs to have legal status. No vote appeared to have been taken on these or the other recommendations. 

Simplexe Malembe, coordinator of FAT, told IRIN that if the government is to give legal status to land allocations by chiefs, it should see that each chief is accompanied by an advisory committee representative of the community. “That principle is already in the constitution,” he said, “and we are trying to implement it through the agricultural law. But the government and the land registry don’t like it because it takes away a good part of their revenue.” 

Participants at the forum agreed that the peasant associations need to strengthen their representation at the local level and their communications with smallholders. 

Photo: Nicholas Long/IRIN

While agriculturalists eke out a living in the hills, this plain in Masisi has been taken for pasture

The International Alert report recommends “bottom-up dialogue” to find local solutions and promote peace-building. Malembe agrees: “In the peasant movement, the dialogue needs to be from the base to the summit as well as from the summit to the base.” 

Jean-Baptiste Musbayimana, who broadcasts for FOPAC, told IRIN he would like to include more phone-in programmes in his broadcasts, a “bottom-up” format popularized by the UN’s Radio Okapi in DRC, so that rural people can share their views on the problems in their communities; currently, the only two-way communication broadcast by FOPAC on the radio is about agricultural prices. 

Government action 

The good news, says Vlassenroot, is that the government appears willing to address land issues nationwide. At a workshop in Kinshasa in July, the government and UN Habitat worked out a “road map” for reform of the land law and land governance. 

The deputy cabinet director at the land affairs ministry, Albert Paka, spoke to IRIN last month about the reform process. He agrees the government needs to hasten reform by taking the first step on the road map: appointing a steering committee to coordinate work on the process. 

But determining who rightfully owns land, and even who is permitted to own land, will be a major hurdle. The new agricultural code, for example, limits foreigners’ share of DRC farmland investments to 49 percent; Paka confirmed that the government intends to revise this clause. Revision of the clause will likely be a precondition for new foreign investments in DRC agriculture. 

Paka said DRC might go the way of other countries and buy up customary land, hinting that such land could be sold to foreign investors. Further research will be required before any decisions can be made, he said. 

Consulting with the chiefs and understanding local customs will also be critical, he told IRIN. “In some parts of the country, land belongs to the chiefs, whereas in other parts it belongs to the community, and they are merely arbiters of land rights.” 

Huggins’s research suggests chiefs’ ownership claims tend to be strongest in the most densely populated areas, where land shortages are most acute. Government land purchases in these areas for resale to foreign investors could therefore be highly controversial. 

“Recognition of customary chiefs will be the cornerstone of land governance,” Paka stressed. 

Asked if there would be safeguards against unjust decisions by traditional chiefs, Paka said that if the chiefs were to be recognized as land custodians they would be part of the administration, and would be guided by its technical experts, whose capacity needs to be reinforced. He declined to speculate on how land administration might change if government at the chiefdom-level is democratized. 

Paka indicated that government intervention will be necessary to help DRC reach its agricultural potential. Even though land shortages are a concern, he pointed out that a recent study showed 73 percent of agricultural land around Kinshasa is unused. 

The National Confederation of Agricultural Producers in the Congo told IRIN that most of the land around Kinshasa is unused because it has been bought up by speculators in anticipation of biofuel investments.