Karin Weyer WHO Stop TB Department Stop TB Partnership Global Laboratory Initiative

Background Health systems weaknesses one of the greatest challenges in TB control Laboratory services one of the weakest links Lack of diagnostic capacity a crucial barrier preventing an effective response to the challenges of HIV-associated TB and drug- resistant TB

From unimaginable…to indispensable Strengthening TB laboratories

Required expansion of Culture capacity: from 10 to 60 mln pa # of tests required (mln) USD funding required (mln) Required expansion of Smear capacity: from 80 to 200 mln pa To reach MDG targets, a global capacity need of 120 million smears, 60 mlllion cultures and 6 million DST investigations must be met by 2015, requiring at least 1 billion USD investment in laboratory infrastructure and annual variable cost 2008 Urgent MDG Target

STP-Global Laboratory Initiative WHA call for universal access to culture and drug susceptibility testing, May 2007 Critical lack of TB laboratory capacity a global crisis Paradigm shift required in laboratory policy guidance, coordination, quality management and knowledge creation STP-GLI endorsed by CB October 2007

STP-GLI components Integration of SLCS and SRLN Global policy guidance Laboratory advocacy and resource mobilization Laboratory capacity development and coordination Uniform standards, procedures, specifications Multi-sectoral and disease cross-cutting approach Coordination of technical assistance Effective knowledge sharing

STP-GLI as an active facilitator of communication and provider of global infrastructure services synchronized to be a coherent network service ~ smear lab centers personnel ~8.000 advanced diagnostic centers – personnel 150 National Reference Labs 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 STP-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

HIVHIV Immun- ization TIERED LABORATORY SERVICES INTEGRATED SERVICE DELIVERY Linked Referral Services Strengthen Laboratory Capacity Training/Retention Logistics and Commodities Management Facility & Equipment Maintenance TBTB Malaria Quality Assurance Integrated systems approach CROSS- CUTTING STREAMS

* WHO, Union, FIND, CDC, Patient Community, National TB Programmes, Supranational & National TB Reference Laboratories Observers, Liaisons with other Working Groups Achievements GLI Core Group* expanded Technical guidance transitioned from volunteer efforts to structured process of expert review and consensus Increase in technical working groups Draft GLI Business Plan Laboratory resources SLD-DST Policy Guidance and Technical Manual Laboratory equipment specifications Laboratory standard operating procedures Biosafety Manual Expansion of WHO Laboratory Team, GLI secretariat

Next Steps/Priorities Refinement of estimates for escalating laboratory capacity under different epidemiological and resource scenarios Modeling of anticipated impact of new technologies Finalization of Business Plan priorities, supported by appropriate resource mobilization plan Prioritization and costing of key activities –Standard-setting –Building laboratory management capacity –Creating conditions for accelerated laboratory strengthening, including private-sector involvement Joint GLI-Fondation Merieux meeting, April 2008