SIAPS TB Core End-of-Project Report

Despite the availability of effective treatment, TB remains a critical global health problem, hindered by pharmaceutical management issues. In 2016, approximately 1.3 million people died of TB, including 374,000 who were HIV-positive. A gap between evidence-based practices and their application in global initiatives resulted in inefficient global TB medicine supply mechanisms. The program objectives and results framework focused on improving governance, leadership, and coordination within and between global initiatives. Human resource capacity and leadership for pharmaceutical supply management and services within TB programs were identified as significant challenges. Other health-systems building blocks, such as management information systems (MIS), definition of standards, and delivery of pharmaceutical services, required individual strengthening and improved synergy. The rapid emergence of drug-resistant (DR-TB) forms of TB added to the challenges. In 2016, approximately 490,000 people worldwide developed multidrug-resistant (MDR)-TB, with only 22% of those enrolled in treatment in 2016. New tools to combat DR-TB, including bedaquiline (Bdq) and delamanid (Dlm), were released onto the market, but uptake has been slow due to a lack of expertise, infrastructure, and appropriate systems to monitor efficacy, safety, and potential adverse effects. Limited access to and improper use of quality assured TB medicines in many high-burden countries were also significant challenges. Limited access to medicines stemmed from a lack of valid quantification information and supply chain bottlenecks at the country level. Access to quality TB diagnosis, treatment, and pharmaceutical services in the private sector remained limited and was often substandard. The SIAPS TB Core Program aimed to build country capacity to improve access to life-saving medicines and technologies for TB patients. The program focused on improving pharmaceutical management, including forecasting and quantification, inventory management, and supply planning. It also aimed to strengthen management information systems (MIS), definition of standards, and delivery of pharmaceutical services. The program's interventions and achievements included the development of a pharmaceutical management information system (PMIS) to track TB medicine stock levels and consumption. The PMIS was implemented in several countries, including Kenya, Tanzania, and Uganda. The program also provided technical assistance to countries to improve their pharmaceutical management systems, including forecasting and quantification, inventory management, and supply planning. The sustainability of SIAPS TB Core interventions and tools was a key consideration. The program aimed to ensure that the interventions and tools developed were sustainable and could be maintained by the countries after the program ended. The program worked with countries to develop national plans and strategies for pharmaceutical management, which would ensure the continued improvement of pharmaceutical management systems. Lessons learned from the program included the importance of building country capacity and strengthening pharmaceutical management systems. The program also highlighted the need for improved coordination and collaboration between global initiatives and countries to address the challenges of TB management. The program's experience with the introduction of new TB medicines, including Bdq and Dlm, also highlighted the need for technical assistance and support to countries to ensure the effective use of these medicines. The SIAPS TB Core Program was a major US Agency for International Development (USAID)-funded mechanism for providing technical leadership in TB pharmaceutical management to global TB initiatives, donors, Stop TB partners, and National TB Programs (NTPs). The program addressed the objectives of the Global Plan to Stop TB 2006–2015 by focusing primarily on strategic components related to increasing the availability of quality assured TB medicines and improving pharmaceutical management systems.