BOX 3-1Related Efforts in SLD Supply Chain and Accessa

Second-Line Drug Access Improvement Initiative (SLDAII)

SLDAII is a joint effort of many leading organizations from the public, private, NGO, and allied fields that was founded on the vision that all patients would be able to access affordable, QA treatment within a sustainable MDR TB SLD drug market. SLDAII focuses on developing the technical information and knowledge needed to make rational decisions and to document why certain risks need to be taken.

The initiative comprises six workstreams, concentrated on the supply side, which are each tied to a goal or set of goals. The manufacturer scale-up and operational forecast workstreams are connected to the goal of increased affordability of IQA SLDs. Supply chain diagnosis and financing mechanisms aim to increase the supply of IQA SLDs. The IQA recommendation and private-sector engagement workstreams target greater operational efficiency. Each goal is also underpinned with a set of specific outcomes that need to be accomplished in order to achieve each goal itself (Figure 3-4).

Michael Kimerling, Senior Program Officer, Tuberculosis Global Health Program, BMGF, suggested that SLDAII fills an important niche in the current environment in helping to ensure coordination and action-oriented progress, but noted that it is open to revision; evaluation is currently underway with the view to ensuring that the right partners are being involved and properly engaged. He said that in moving forward strategically, a shift in focus is needed from identifying barriers to creating innovative solutions and from writing documents to writing business plans. Integrating the private sector will require learning its language and analyzing its needs, which will aid in adapting to a changing market. All efforts should be focused on working urgently and systematically toward a common and clearly established set of principles: ensuring uninterrupted and universal access to the QA drugs at affordable prices.

MDR TB Innovation Summit

Tracy Sims, Vice President, Eli Lilly & Co. Foundation, described ideas that were generated in an MDR TB Innovation Summit that was convened in May 2012.b The Innovation Summit tackled the following clearly defined problem statement:

What innovative approaches/products can be implemented (either directly or indirectly) that would overcome the supply chain barriers that today prevent IQA SLDs from reaching the entire global population of MDR TB patients?

The Summit included participants from both within and outside the sphere of MDR TB expertise who were tasked with dissecting the problem, analyzing it, and producing actionable outcomes. The underlying strategic concepts driving the Summit were the need to take action, develop new approaches, involve new people, engage in partnership, and take well-informed risks.

The initial step in the process employed at the 2-day Summit was to clearly identify the problem and segregate the problem space into five pieces:

  1. demand for care;
  2. purchasing and procurement;
  3. production, QA, and QC;
  4. logistics; and
  5. delivery of care.

Barriers to the delivery of medication from both the supply and demand sides were identified, and the participants were divided into teams to address each of the identified barriers separately. The teams developed idea fragments, which were then accumulated into unique idea resumes against each barrier and ultimately refined into 12 idea platforms. Five of those platforms were identified as having the strongest potential for resolving major challenges and were developed into emergent, actionable strategies (Figure 3-5).

Sims explained how the five strategies might address their respective barriers in the SLD supply chain:

  • Case Tracker: A mobile-enabled incident-reporting and treatment system to pool data, stimulate action, track demand for care, and enable more detailed forecasting.
  • Global Connect: A mobile, Web-based system to support HCP adherence to recommended treatment and improve delivery of care.
  • TB Impact Network: A moderated network of global efforts to treat and prevent TB and MDR TB and to improve collaboration.
  • Health Express: A Web-based product-tracking and procurement support system to improve QA SLD supply chain visibility.
  • New TB “Brand”: Development of a consolidated voice or campaign for MDR TB to drive accountability and heighten awareness of the urgency of MDR TB nationally and internationally.
FIGURE 3-4. SLDAII vision and goals.


SLDAII vision and goals. NOTES: Arrows represent connection between workstreams to different goals; IQA, internationally quality-assured; PQ, prequalified; SLD, second-line anti-TB drug. SOURCE: Kimerling, 2012. Presentation at IOM workshop on Developing (more...)

FIGURE 3-5. Owner/participant teams for the top five MDR TB Innovation Summit ideas.


Owner/participant teams for the top five MDR TB Innovation Summit ideas. NOTE: HCP, health care professional; IQA, internationally quality-assured; QA, quality-assured; QC, quality control. SOURCE: Sims, 2012. Presentation at IOM workshop on Developing (more...)


This box is based on the presentations by Michael Kimerling, Senior Program Officer, Tuberculosis Global Health Program, BMGF, and Tracy Sims, Vice President, Eli Lilly & Co. Foundation.


Partners included the Eli Lilly & Co. Foundation, the Stop TB Partnership, and the Innosight Consulting Firm.

From: 3, Financing of MDR TB SLDs

Cover of Developing and Strengthening the Global Supply Chain for Second-Line Drugs for Multidrug-Resistant Tuberculosis
Developing and Strengthening the Global Supply Chain for Second-Line Drugs for Multidrug-Resistant Tuberculosis: Workshop Summary.
Institute of Medicine (US) Forum on Drug Discovery, Development, and Translation.
Washington (DC): National Academies Press (US); 2013.
Copyright © 2013, National Academy of Sciences.

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