Appendix A

Workshop Agenda

FACING THE REALITY OF DRUG-RESISTANT TUBERCULOSIS
IN INDIA: CHALLENGES AND POTENTIAL SOLUTIONS

April 18-19, 21, 2011
Indian National Science Academy
New Delhi, India

Background

The increasing burden of drug-resistant tuberculosis (MDR TB/XDR TB) introduces new challenges to traditional TB control and treatment programs and calls upon the global health community to collaborate and share scientific information in new and different ways. This 2-day workshop is sponsored by the Forum on Drug Discovery, Development, and Translation of the U.S. National Academy of Sciences, the Institute of Medicine (IOM), the Indian National Science Academy (INSA), and the Indian Council of Medical Research (ICMR). The workshop is the third in a series of international workshops convened by the U.S. IOM. The objectives of the workshop series are:

  • The multi-disciplinary workshops span a wide spectrum of issues pertaining to the science and policy around drug-resistant tuberculosis—from biology, epidemiology, and surveillance; to diagnosis, treatment, and infection control; to issues pertaining to the drug supply chain, laboratory capacity, and needs of vulnerable populations. Each workshop will address some or all of these multiple disciplines and facilitate discussion about a broad “blueprint for action.”
  • The workshops are an opportunity to present promising new research and also to identify specific gaps in knowledge calling for more research, funding, and international attention.


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Appendix A Workshop Agenda FACING THE REALITY OF DRUG-RESISTANT TUBERCULOSIS IN INDIA: CHALLENGES AND POTENTIAL SOLUTIONS April 18-19, 21, 2011 Indian National Science Academy New Delhi, India Background The increasing burden of drug-resistant tuberculosis (MDR TB/XDR TB) introduces new challenges to traditional TB control and treatment pro- grams and calls upon the global health community to collaborate and share scientific information in new and different ways. This 2-day workshop is sponsored by the Forum on Drug Discovery, Development, and Transla- tion of the U.S. National Academy of Sciences, the Institute of Medicine (IOM), the Indian National Science Academy (INSA), and the Indian Coun- cil of Medical Research (ICMR). The workshop is the third in a series of international workshops convened by the U.S. IOM. The objectives of the workshop series are: • The multi-disciplinary workshops span a wide spectrum of issues pertaining to the science and policy around drug-resistant tuberculosis—from biology, epidemiology, and surveillance; to diagnosis, treatment, and infection control; to issues pertaining to the drug supply chain, laboratory capacity, and needs of vulnerable populations. Each workshop will address some or all of these mul- tiple disciplines and facilitate discussion about a broad “blueprint for action.” • The workshops are an opportunity to present promising new research and also to identify specific gaps in knowledge calling for more research, funding, and international attention. 129

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130 DRUG-RESISTANT TUBERCULOSIS IN INDIA • The workshop series is being hosted over a period of several years, which will create a venue and body of knowledge that can explic- itly consider and address developments over a period of a few years, thus permitting relatively quick adjustments in knowledge and strategy. • The workshop series convenes international experts, permitting exchange of information among experts from each of the partici- pating countries and globally. • Each workshop in the series will result in publication by the U.S. National Academies of a summary document that reports the pro- ceedings from each country-specific workshop. This workshop in New Delhi will address the current status of drug- resistant tuberculosis in India and across the globe; highlight key challenges to controlling the spread of drug-resistant strains; and discuss innovative strategies to advance and harmonize local and international efforts to pre- vent and treat drug-resistant TB. DAY 1 8:30-9:00 a.m. Registration and Tea Welcomes, Background, and Workshop Objectives 9:00-9:40 a.m. Krishan LaL Indian National Science Academy GaiL CasseLL, Forum Co-Chair Harvard Medical School Infectious Disease Research Institute PraKash n. Tandon Indian National Science Academy Vishwa Mohan KaToCh Indian Council of Medical Research Keynote Addresses 9:40-10:00 a.m. ashoK KuMar Revised National TB Control Program (RNTCP) Ministry of Health and Family Welfare

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131 APPENDIX A 10:00-10:20 a.m. K. srinaTh reddy Public Health Foundation of India Setting the Stage: Global Challenges and Potential 10:20-10:40 a.m. Solutions saLMaan KeshaVjee Harvard Medical School 10:40-11:05 a.m. Tea Break SESSION I: DRUG-RESISTANT TB IN INDIA Session Objectives: § rovide an introduction to the global challenge of drug- P resistant TB and consequences of inaction. § escribe the epidemiology of drug-resistant TB in India. D § escribe the drug-resistant TB risk factors and provide D in-country perspectives of the issues and current strategies for prevention and control. Session Chair: Salmaan Keshavjee, Harvard Medical School § National Scale-Up of Drug-Resistant TB Diagnosis and Treatment 11:05-11:20 a.m. KuLdeeP sinGh saChdeVa RNTCP Ministry of Health and Family Welfare Overview of Drug-Resistant TB in India 11:20-11:35 a.m. Prof. s. K. sharMa All India Institute of Medical Sciences (AIIMS) Improving Health System Performance to Address 11:35-11:50 a.m. the Challenge of Drug-Resistant TB aLeyaMMa ThoMas Tuberculosis Research Centre, Chennai

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132 DRUG-RESISTANT TUBERCULOSIS IN INDIA 11:50a.m.- Lunch 1:15 p.m. SESSION II: GLOBAL BURDEN OF DRUG-RESISTANT TB Session Objectives: § eport on findings from previous IOM workshops in South R Africa and Russia. § resent the latest epidemiological and laboratory data P describing the estimated burden of drug-resistant TB worldwide, with a focus on high-burden countries other than India (e.g., South Africa, China, and Russia). § ighlight differences and different trajectories of the drug- H resistant TB epidemic globally. Session Chair: § ail Cassell, Harvard Medical School and Infectious Disease G Research Institute Overview of Findings from IOM Workshop Series 1:15-1:45 p.m. China data provided by Mingting Chen, Centers for Disease Control GaiL CasseLL Harvard Medical School Infectious Disease Research Institute Overview of Global Drug-Resistant TB Burden 1:45-1:55 p.m. WHO data provided by Matteo Zignol and presented by: saLMaan KeshaVjee Harvard Medical School Updates from Other Countries 1:55-2:00 p.m. GaiL CasseLL Harvard Medical School Infectious Disease Research Institute

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133 APPENDIX A SESSION III: PREVENTING TRANSMISSION OF DRUG-RESISTANT TB Session Objectives: § rovide an overview of the molecular evidence for P transmission of drug-resistant TB. § iscuss the background and rationale for India’s Revised D National TB Control Program methods to prevent transmission of drug-resistant TB and the program’s future goals. § iscuss the genetic evolution of M.tb. and current best D practices in infection control. Session Chairs: § dward Nardell, Harvard Medical School/Partners In Health E § shok Kumar, RNTCP A Importance of Engaging the Private Sector in 2:00-2:15 p.m. MDR TB Prevention and Case-Finding PuneeT dewan WHO Drug-Resistant TB Transmission and Reactivation/ 2:15-2:30 p.m. Reinfection Phenomenon s. siVa KuMar Tuberculosis Research Centre, Chennai Indian Program Efforts to Prevent Transmission of 2:30-2:45 p.m. Drug-Resistant TB PrahLad KuMar National Tuberculosis Institute, Bangalore Population Ecology and the Genetic Evolution of 2:45-3:00 p.m. M.tb. sébasTien GaGneux Swiss Tropical and Public Health Institute

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134 DRUG-RESISTANT TUBERCULOSIS IN INDIA TB Infection Control Reconsidered: The Impact of 3:00-3:15 p.m. Treatment on MDR TB Transmission edward nardeLL Harvard Medical School/Partners In Health Roundtable Discussion 3:15-3:30 p.m. Open Discussion with Workshop Participants 3:30-3:45 p.m. Tea Break SESSION IV: RAPID METHODS OF DETECTING DRUG RESISTANCE AND STRENGTHENING OF LABORATORY CAPACITY Session Objectives: § rovide an overview of current diagnostic methods and P identify gaps/current needs that are not being met with tests in use today. § onsider the next generation of TB diagnostics (e.g., level of C resistance that will be detected, use of a test at the point of patient care, specimen processing). § onsider the validation of diagnostic tests and other quality C assurance measures. Session Chairs: § homas Shinnick, U.S. Centers for Disease Control and T Prevention (CDC) § arman Singh, AIIMS S Treatment of Drug-Resistant TB 3:45-4:00 p.m. rohiT sarin Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases Diagnosis of Drug-Resistant TB 4:00-4:15 p.m. CaMiLLa rodriGues Hinduja Hospital and Medical Research Center

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135 APPENDIX A Moving Towards the Next Generation of Diagnostic 4:15-4:40 p.m. Tests for Drug-Resistant TB: Quality Assurance Considerations in the Development of New Diagnostics ThoMas shinniCK Division of Tuberculosis Elimination U.S. Centers for Disease Control and Prevention (CDC) Supranational Reference Laboratory and Private 4:40-5:00 p.m. Laboratories in RNTCP naGaMiah seLVaKuMar Tuberculosis Research Centre, Chennai Laboratory Capacity in India for the Diagnosis of 5:00-5:15 p.m. Drug-Resistant TB: Update on EXPAND-TB Efforts neeraj raizada Foundation for Innovative New Diagnostics (FIND) Roundtable Discussion 5:15-5:45 p.m. Open Discussion with Workshop Participants DAY 2 SESSION V: REACHING VULNERABLE POPULATIONS AFFECTED BY DRUG-RESISTANT TB Session Objectives: § iscuss ways to address priorities of reaching and treating D drug-resistant TB patients in the large Indian population. § resent data on the burden of drug-resistant TB and treatment P methods in vulnerable populations such as children, migrants, refugees, and HIV-infected populations.

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136 DRUG-RESISTANT TUBERCULOSIS IN INDIA Session Chairs: § ercedes Becerra, Harvard Medical School M § oumya Swaminathan, WHO1 S Addressing Drug-Resistant TB in Pediatric 9:00-9:15 a.m. Populations souMya swaMinaThan WHO Burden of Pediatric Tuberculosis in Households of 9:15-9:30 a.m. Patients with MDR TB MerCedes beCerra Harvard Medical School Drug Resistance in India’s HIV-Infected Population 9:30-10:00 a.m. diGaMbar behera Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases Drug-Resistant TB in Migrant and Refugee Populations KunChoK dorjee Tibetan TB Control Programme, Department of Health, Tibetan Government in Exile Roundtable Discussion 10:00-10:30 a.m. Facilitator: Anne Goldfeld, Global Health Committee/Cambodian Health Committee, Harvard Medical School 10:30-11:00 a.m. Tea Break 1 At the time of the workshop, Soumya Swaminathan was Coordinator for Neglected Pri- orities Research with the WHO’s Special Programme for Research and Training in Tropical Diseases. Since the workshop, Swaminathan has rejoined the National Institute for Research in Tuberculosis as Head, Division of Clinical Research.

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137 APPENDIX A SESSION VI: CASE STUDIES IN INNOVATIVE DRUG- RESISTANT TB CONTROL EFFORTS Session Objectives: § iscuss the use of mobile technology to track disease, train the D TB workforce, and improve overall TB health care delivery. § resent innovative methods or alternative development P strategies to improve control and treatment of drug-resistant TB. Session Chair: § anet Tobias, Mount Sinai School of Medicine J Leveraging Technology and Unique Development Models to Improve Access to Care and Compliance with Treatment Regimens Case Study: Mobile Technology to Improve Drug- 11:00-11:15 a.m. Resistant TB Control and Care in Karachi aaMir Khan [by teleconference] Indus Hospital, Pakistan Operation ASHA—Using Innovations and 11:15-11:30 a.m. Biometrics to Prevent MDR TB and Provide a Social and Economic Return sheLLy baTra Operation ASHA, New Delhi MDR TB in Ethiopia: Failure of the International 11:30-11:45 a.m. Response and How an NGO Filled the Gap anne GoLdfeLd Global Health Committee/Cambodian Health Committee Harvard Medical School 11:45 a.m.- Discussion 12:15 p.m. 12:15-1:15 p.m. Lunch

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138 DRUG-RESISTANT TUBERCULOSIS IN INDIA SESSION VII: DRUG SUPPLY CHAIN Session Objectives: § resent current methods of drug procurement in India, P successes, and current challenges to effectively delivering quality-assured second-line drugs to patients. Session Chairs: Iain Richardson, Eli Lilly & Co. § § radeep Saxena, Central TB Division, Directorate General of P Health Services Setting the Stage: Challenges in Drug Supply Chain 1:15-1:30 p.m. Logistics PrashanT yadaV MIT-Zaragoza International Logistics Program Implementation of India’s National MDR TB 1:30-1:45 p.m. Program PradeeP saxena RNTCP Ministry of Health and Family Welfare Potential for Impact in Second-Line TB Drug 1:45-2:00 p.m. Pricing inder sinGh Clinton Health Access Initiative Moving Towards a Functional Second-Line TB Drug 2:00-2:15 p.m. Market owen robinson Partners In Health Roundtable Discussion 2:15-2:45 p.m. Facilitator: Anne Goldfeld, Global Health Committee/Cambodian Health Committee, Harvard Medical School

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139 APPENDIX A 2:45-3:15 p.m. Tea Break SESSION VIII: CLOSING PLENARY: THE INTERSECTION OF SCIENCE AND POLICY: CREATING A BLUEPRINT FOR ACTION Session Objectives: § iscuss potential policy approaches to address problems and D gaps considered during the workshop. § ow can domestic programs and international partners work H together to create a “blueprint for action” to address the problem of drug-resistant tuberculosis? § onsider opportunities to address the problem of drug- C resistant tuberculosis in India’s next 5-year budget plan. Session Chairs: § laine Gallin, QE Philanthropic Advisors E § eyed E. Hasnain, Indian Institute of Technology S 3:15-4:45 p.m. Panelists: § iran Katoch K § rakash N. Tandon P § ail Cassell G § almaan Keshavjee S Open Discussion with Workshop Participants

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