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[The results of implementation of the International Bank for Reconstruction and Development Loan Project "Prevention, diagnosis, and treatment of tuberculosis and AIDS", a "tuberculosis" component]
Tuberkulez I Bolezni Legkikh. 2010; (3):10-7.Due to the implementation of the International Bank for Reconstruction and Development (IBRD) loan project "Prevention, diagnosis, treatment of tuberculosis and AIDS", a "Tuberculosis" component that is an addition to the national tuberculosis control program in 15 subjects of the Russian Federation, followed up by the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences, the 2005-2008 measures stipulated by the Project have caused substantial changes in the organization of tuberculosis control: implementation of Orders Nos. 109, 50, and 690 and supervision of their implementation; modernization of the laboratories of the general medical network and antituberbulosis service (404 kits have been delivered for clinical diagnostic laboratories and 12 for bacteriological laboratories, including BACTEC 960 that has been provided in 6 areas); 91 training seminars have been held at the federal and regional levels; 1492 medical workers have been trained in the detection, diagnosis, and treatment of patients with tuberculosis; 8 manuals and guidelines have been prepared and sent to all areas. In the period 2005-2008, the tuberculosis morbidity and mortality rates in the followed-up areas reduced by 1.2 and 18.6%, respectively. The analysis of patient cohorts in 2007 and 2005 revealed that the therapeutic efficiency evaluated from sputum smear microscopy increased by 16.3%; there were reductions in the proportion of patients having ineffective chemotherapy (from 16.1 to 11.1%), patients who died from tuberculosis (from 11.6 to 9.9%), and those who interrupted therapy ahead of time (from 11.8 to 7.8%). Implementation of the IBR project has contributed to the improvement of the national strategy and the enhancement of the efficiency of tuberculosis control.
Washington, D.C., World Bank, Human Development Network, Health, Nutrition and Population Team, 2007 Aug. 51 p. (Policy Research Working Paper No. 4295)Tuberculosis is the most important infectious cause of adult deaths after HIV/AIDS in low- and middle-income countries. This paper evaluates the economic benefits of extending the World Health Organization's DOTS Strategy (a multi-component approach that includes directly observed treatment, short course chemotherapy and several other components) as proposed in the Global Plan to Stop TB, 2006-2015. The authors use a model-based approach that combines epidemiological projections of averted mortality and economic benefits measured using value of statistical life for the Sub-Saharan Africa region and the 22 high-burden, tuberculosis-endemic countries in the world. The analysis finds that the economic benefits between 2006 and 2015 of sustaining DOTS at current levels relative to having no DOTS coverage are significantly greater than the costs in the 22 high-burden, tuberculosis-endemic countries and the Africa region. The marginal benefits of implementing the Global Plan to Stop TB relative to a no-DOTS scenario exceed the marginal costs by a factor of 15 in the 22 high-burden endemic countries, a factor of 9 (95% CI, 8-9) in the Africa region, and a factor of 9 (95% CI, 9-10) in the nine high-burden African countries. Uncertainty analysis shows that benefit-cost ratios of the Global Plan strategy relative to sustained DOTS were unambiguously greater than one in all nine high-burden countries in Africa and in Afghanistan, Pakistan, and Russia. Although HIV curtails the effect of the tuberculosis programs by lowering the life expectancy of those receiving treatment, the benefits of the Global Plan are greatest in African countries with high levels of HIV. (author's)
Lancet. 2007 Feb 24; 369(9562):626-627.In today's Lancet, Longde Wang and colleagues report on many remarkable recent improvements in the control of tuberculosis in China. The progress is good news in view of the size and global importance of the tuberculosis burden in China and the faltering of control in the 1990s, as noted by Wang. The fruitful partnership with WHO, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and several governments and non-governmental organisations is also noteworthy, as is the commitment to transparent reporting and health-system reform in China today in the environment after the outbreak of severe acute respiratory syndrome. Better control of tuberculosis in China is also timely in view of the high rates of multidrug resistance, and the emergence of HIV infection in some population subgroups also at high risk of tuberculosis. One group of special concern are work migrants, most often poor young men, who leave the countryside to join the wage economy in towns and cities all over China. Some come from areas such as Henan Province where huge numbers of peasants were infected with HIV from scandalous plasma--donor practices in the 1990s. Many male migrants are at risk of unprotected sex when away from home. And men are also at higher risk of tuberculosis than women in China because the male-to-female ratio of adults with pulmonary tuberculosis is about 2:1 or more, reflecting a real risk excess rather than differential detection or notification. So several factors converge in young male migrant workers to put them at risk of both HIV and tuberculosis, and this convergence must be of great concern. (excerpt)
Impact of external assistance: review of the tuberculosis programme in Karnataka, India (1999-2001).
Health Administrator. 2003 Jan-Jul; 15(1-2):102-105.RNTCP in Karnataka is a centrally sponsored project financed by the World Bank at a total cost of about 18 crores. Inspite of the fact that Karnataka has been a pioneer in initiating Tuberculosis Programme, the state stands listed with Assam, Bihar, J&K, Madhya Pradesh, Meghalaya, Mizoram, Punjab and Uttar Pradesh as the most difficult areas for implementation. Questions are raised as to the impact of external assistance in the control and implementation of the Tuberculosis Programme. (excerpt)
Significance of foreign funding in developing health programmes in India - the case study of RNTCP in the overall context of North-South co-operation.
Health Administrator. 2003; 15(1-2):52-60.External assistance on disease containment and health policy has been a global phenomenon ever since the advent of modern medicine. The technically and resource advanced countries have been contributing to health programs of the resource constrained nations particularly with an objective of disease containment and eradication. India has its own history of receiving external assistance for its health programs since 1950s. Eradication of Small Pox, control of Malaria in 1970s, Family Planning Program, Universal Immunization Program (UIP), Pulse Polio and more recently campaigns against Human Immune-deficiency Virus (HIV) and Tuberculosis Programme had been supported by bilateral or multilateral aids. External assistance in India is small in terms of its proportion to the Gross Domestic Product (GDP). In health, it has never been more than 1-3 % of the total public health spending in any given year. Yet external assistance has had a profound impact on health, as technical support obtained from such assistance has made a significant contribution to hastening India’s demographic and epidemiological transition. The present paper reviews the issue of foreign funding in health programmes and specifically highlights its impact of TB Programme development in India. (excerpt)
[Unpublished] 2000 Apr. 11 p.Malaria, tuberculosis, and the strains of AIDS common in developing countries kill five million people each year. Over the last 50 years, these diseases have killed six times as many people as have died in all wars. Yet research on vaccines for these diseases remains minimal. This is in large part because R&D on vaccines is a global public good in which no one country has sufficient incentive to invest. It is also because these diseases primarily affect poor countries, and therefore potential vaccine developers believe they will be unable to sell enough vaccine at a sufficient price to recoup their research costs. World Bank president James Wolfensohn recently said that the institution plans to create a $1 billion fund to help countries purchase specified vaccines if and when they are developed. Such a fund could help ensure that there would be a market for malaria, tuberculosis, or AIDS vaccines if they were developed, and thus would create incentives for vaccine research. It could also help ensure that any vaccines developed would be affordable in poor countries. The program would be highly focused on areas of deep poverty and would be highly cost effective. (excerpt)
[Unpublished] 2000 Apr 13. 64 p.Malaria, tuberculosis, and African strains of AIDS kill almost 5 million people annually, primarily in poor countries. Despite recent scientific advances, research on vaccines for these diseases remains minimal. This is in large part because potential vaccine developers fear that they could not sell enough vaccine at a sufficient price to recoup their research expenditures. The U.S. administration and the World Bank have each recently proposed programs that would help developing countries to purchase vaccines for these diseases, if and when they are developed. Such programs could both create incentives for vaccine research and help increase accessibility of vaccines once they are developed. This paper explores the design of such programs. It focuses on commitments to purchase new vaccines. For vaccine purchase commitments to spur research, potential vaccine developers must believe that the sponsor will not renege on the commitment once vaccines have been developed and research costs sunk. There is a tradeoff between enhancing credibility with potential vaccine developers by specifying rules for vaccine eligibility and pricing in detail, and preserving flexibility to judge suitability of vaccines after they have been developed and tested. In any case, eligibility will need to be interpreted after candidate vaccines have been developed. The credibility of purchase commitments can be enhanced by including industry representatives on committees making eligibility decisions, insulating committee members from political pressure through long terms, and establishing a minimum price for vaccine purchases under the program. (excerpt)
[Unpublished] 2000 Apr 13. 49 p.Malaria, tuberculosis, and AIDS kill approximately 5 million people each year. The overwhelming majority of deaths occur in poor countries. Despite recent scientific advances, research on vaccines for malaria, tuberculosis, and African strains of HIV remains minimal. This is in large part because potential vaccine developers fear that they would not be able to sell enough vaccine at a sufficient price to recoup their research expenditures. This paper sets out the economic rationale for committing in advance to purchase vaccines once they are developed. The U.S. administration’s budget proposal includes a tax credit for vaccine sales. The World Bank has proposed establishing a vaccine purchase fund. Such commitments could potentially create incentives for vaccine research and help increase the accessibility of any vaccines developed. (excerpt)
Arlington, Virginia, Management Sciences for Health [MSH], Center for Pharmaceutical Management, Rational Pharmaceutical Management Plus Program, 2001. iv, 9 p. (USAID Contract No. HRN-A-00-00-00016-00)As part of its contribution to USAID’s SO5—reduce the threat of infectious diseases of major public health importance, the Rational Pharmaceutical Management (RPM) Plus program is providing technical support to the national Tuberculosis (TB) program in Vietnam through the SO5 ID/TB Activity 3: Conduct TB drug procurement training in Vietnam. The RPM Plus assistance will facilitate Vietnam’s procurement of TB drugs under a secured World Bank project. Thomas Moore of RPM Plus and Hugo Vrakking of Royal Netherlands Tuberculosis Association (KNCV) traveled to Vietnam to conduct the training course. The Ministry of Health (MOH) has recently reorganized its procurement department, devolving procurement activities to respective vertical programs such as Tuberculosis, Malaria, and Hematology. Course participants (listed in Annex 1: Proceedings of the Training Workshop—Vietnam) are members of the management committee of the national TB program (NTP). All are expected to play some part in the procurement of TB drugs. (excerpt)
InterDependent. 2004 Spring; 22-23.However, there is reason for optimism. Proven methods of prevention and treatment exist and there is mounting evidence that the disease can be brought under control. The problem is resources. While the level of funding and political commitment to address the epidemic has improved dramatically in the last few years, more is needed. The U.N. estimates that by 2005, over $10.5 billion will be required per year to combat the disease in developing countries, where 95 percent of those infected with HIV live. Yet, in 2003, only about $4.7 billion was spent for this purpose. Recognizing the crucial importance of generating increased financing, the international community, led by U.N. Secretary-General Kofi Annan, began calling for the creation of a global health fund in early 2000. With strong support from the United States, the Global Fund to Fight AIDS, Tuberculosis and Malaria was established in January 2002 to dramatically increase resources to fight three of the world's most devastating diseases. (excerpt)
The new lepers. HIV-positive people are treated as social outcasts while the government fails to cope.
London, England, Institute for War and Peace Reporting [IWPR], 2003 Aug 8. 3 p. (Belarus Reporting Service No. 28)More and more people in Belarus are finding themselves in her position – 50 or 60 new HIV cases are recorded every month. At the beginning of August, the number of people carrying the virus reached 5,150, and experts fear that the figure will be more than double that in 2005. More worryingly, some say the recorded figures should be multiplied by a factor of three or more since they fail to capture drug users who have not been seen by the health authorities. Although HIV and AIDS are advancing rapidly, neither the government nor society in general appear able to come to terms with it. A survey conducted jointly by the United Nations and the Centre for Sociological and Political Research in Minsk found that three quarters of the people polled thought people with HIV should not be allowed to care for their own children, and more than 40 per cent said they should not be allowed to travel around the country or choose where they want to live. (excerpt)
Lancet. 2003 Apr 19; 361(9366):1355.Russia’s health system received a boost on April 3 when the World Bank approved a long-delayed loan delivering US$100 million for federal tuberculosis programmes, coupled with $50 million for HIV/AIDS efforts. Russia first requested the loan in 1999, but wrangling over tuberculosis treatment strategies and sourcing for commercial tuberculosis drugs forced years of delay, even as the disease continued to kill 30 000 people per year, and HIV cases skyrocketed. (excerpt)
Drug-resistant strains of TB increasing worldwide. New WHO report shows super-deadly TB strain is spreading. Drug resistant cases increase by 50% in parts of Western Europe. Countries to announce urgent control measures at ministerial summit. Press release.
Geneva, Switzerland, WHO, 2000 Mar 24 2 p. (Press Release WHO/19)Multidrug resistant (MDR) tuberculosis (TB) is a strain that cannot be cured with the most effective anti-TB medicines. The WHO and the International Union Against TB and Lung Disease warns that if countries do not act quickly to strengthen their control of TB, the MDR strains will continue to emerge in other parts of the world. It is reported that MDR strains have cost hundreds of lives and more than US$1 billion each in New York and Russia. Since 1996, resistance to at least one TB drug has increased by 50% in both Denmark and Germany, and it has doubled in New Zealand. It is also reported that when drug resistance is permitted to flourish in developing countries, people in wealthy countries inevitably feel the consequences. However, countries that use the WHO's recommended Direct Observation Treatment, Short-course, also known as DOTS, have been able to prevent drug resistance from increasing. The governments of the 20 countries with the largest number of TB patients are expected to announce a series of initiatives to prevent the MDR crisis from worsening. The WHO and the World Bank have called the meeting in Amsterdam to plan strategies to stop the spread of MDR-TB, and reduce deaths from TB.
HEALTH FOR THE MILLIONS. 1995 Jan-Feb; 21(1):29-33.In India, the standard regimen (SR) for treating tuberculosis consisted of a 2-month intensive treatment by 2-3 inexpensive drugs followed by a 10-month course using 2 drugs. In the 1980s, this course was shortened to 6 months owing to the powerful drugs rifampicin and pyrazinamide. Thiacetazone was also replaced by the more expensive but less toxic ethambutol. The result was a short-course chemotherapy (SCC) employing 4 drugs for 2 months, followed by 2-3 drugs for 4 months of follow-up. The SCC is being pilot-tested as the Revised National Tuberculosis Program (RNTP); this RNTP strategy is being implemented in Delhi, Bombay, and Mehsana with the assistance of the Swedish international agency. The World Bank also endorsed RNTP, as SCC regimens under it were cost-effective. The SR and SCC regimens were also compared for Malawi, Mozambique, and Tanzania, and relatively minor differences were found in lives saved for expenditures. The claim that the rates of default under SR and SCC remain unchanged over time and the cure rates of the regimens must be challenged. The estimated cure rates of 60% for SR and 85% for SCC do not correspond to the reality in India, where 41% of patients completed treatment under SR versus 47% under SCC. The cost of treatment under SR does not have to be a 5-drug regimen; re-treatment can be a 3-drug regimen, whereby the cost would be lower than assumed. The Ministry of Health and Family Welfare (MHF) was probing 253 district SCCs even in 1992-93 and accepted SCC because the World Health Organization recommended a vastly improved administration for implementation and there was a felt need from patients for speedy cure. If the SCC is administered properly, it may increase the cure rate, even if cost-ineffective; if poorly managed, increased drug resistance of TB bacteria could result, which may be the present situation.
WORLD HEALTH. 1993 Jul-Aug; 46(4):30-1.The cost to eradicate the small pox virus was US$300 million. Smallpox eradication saved millions of lives. The US spent $100 million in a few months to make sure there would be no more cyanide poisonings from pain relievers in the Chicago area, but few if any lives were saved by this effort. Many public health needs force officials to determine which health interventions are the most cost effective. The World Bank and WHO have developed a common standard with which to make health care comparisons call the disability-adjusted life year (DALY). Officials relate the costs of preventing or treating a disease to the number of healthy years of life gained by an intervention to determine cost effectiveness. The formula is more involved for infectious diseases, since treating them prevents further infections, e,g., tuberculosis (TB). The 1993 World Development Report reveals TB is among the most cost-effective diseases to control in adults older than 15 year olds. Studies in sub-Saharan Africa show that the cost of treating a TB-infected patient can be as low as $20 and never higher than $100, equalling as little as $.90 for each year of life saved. The 6-month chemotherapy regimen is the most cost-effective intervention of TB control programs. Other cost-effective interventions are the 12-month treatment and hospitalizing patients throughout treatment. As much as 40% of public health expenditures are for interventions with low cost effectiveness, e.g., heart surgery and intensive care for premature babies. Yet, critical and very cost-effective interventions, such as TB treatment, receive little funding. The Report contends that if funding of higher cost-effective health interventions increases, governments could save millions of lives and billions of dollars. TB prevention will stem the development of multidrug resistant strains of TB. If the $100 million spent in 1992 to prevent cyanide deaths could have been spent to address the emerging disease, AIDS, perhaps many people would have not been infected with HIV.
WORLD HEALTH. 1993 Jul-Aug; 46(4):24-5.The World Bank has loaned CHina funds to revitalize its tuberculosis (TB) program in 12 provinces. The 7-year project aims to cure infectious TB patients which, in turn, stops TB transmission it he community. The program's main strategies include passive case finding, diagnosis by sputum smear, and completely supervised short-course chemotherapy by village doctors. The program provides small financial incentives to motivate peripheral health workers to detect and cure infectious TB patients. WHO provides the World Bank technical assistance in determining progress and trouble-shooting. In 1992, the program diagnoses about 20,000 new and previously treated cases. It has successfully cured more than 90% of newly diagnoses cases and 72% of retreated cases. In the countries of Hebei province where the pilot project began, the cure rate of new patient was 96% and 81% for retreated cases. No TB patients in the pilot areas were lost to follow up. The largest percentage of newly detected smear positive cases was 25-44 years olds. There were 27% more men with TB than women. The lower success rates for retreated cases were likely due to these cases carrying bacteria resistant to 1 or more drugs. The size of the group of these difficult patients fell rather rapidly, however. The program is proving quite successful, especially in the poorest rural counties. Assistance from the World Bank and WHO has se tin motion an effective TB control program which operates under the primary health care approach.
Lancet. 1993 Jul 10; 342(8863):63-4.The report "Investing in Health," from the World Bank, reflects recent changes in international health, including AIDS, and the world's attention to Central Europe and the former Soviet Union. Cardiovascular disease is now the leading cause of death in the developing world. The health problems of urban areas and violence (especially towards women) are emphasized, with details on the economic and social impact of ill-health on the household. The cost effectiveness of an essential drugs policy is admitted, and the negative health (and economic) effects of tobacco are described. Public health in developing countries is assessed from an economic viewpoint. It is conceded that in some countries Structural Adjustment Programs (SAP) were indiscriminate and failed to preserve important elements of health services. There is strong evidence that user fees can be disastrous. In China, when drug charges of $30-80 were instituted for tuberculosis in 1981, 1-1.5 million cases remained untreated, producing in turn an additional 10 million infections. Many of the 3 million Chinese who died of tuberculosis during the 1980s could have been saved. There is, however, a controversial estimate of the global burden of disease and the package designed to reduce that burden. This involved estimating, for 131 diseases, the incidence of cases in 1990 by age, sex, and region. Estimates of cost per intervention in terms of disability-adjusted life years (DALY) yield packages of basic services, which would cost $12 per person in low-income countries. An intervention costing less than $100 per DALY is considered a very good buy. The cheapest, at <$25, include promotion of breast-feeding, immunizations, salt iodization and vitamin A supplementation, anthelmintics, smoking prevention, use of condoms, and cataract removal. At >$1000 per DALY are surgical and medical treatment of chronic diseases and cancers and control of dengue fever; this is apparently too expensive for many developing countries.
TROPICAL AND GEOGRAPHICAL MEDICINE. 1991 Jul; 43(3):S13-21.Tuberculosis (TB) has long been recognized as a complication of immune suppression. It poses a particularly major public health threat to developing countries. Many developing countries suffer high prevalence and incidence of TB infection. By suppressing host cell-mediated immunity, HIV exacerbates TB infection by helping to facilitate the transition of latent TB into active disease. Higher prevalence of active disease in population then leads to increasing rates of TB transmission. The World Bank estimates an annual incidence of greater than 7.1 million TB cases in the developing world. Cost-effective interventions have, however, been incorporated as components of national programs in Tanzania and other developing countries. The World Health Organization and World Bank are also working on new strategies to revitalize global efforts against tuberculosis. Finding TB cases early and treating them with chemotherapy are specifically recommended.
Washington, D.C., World Bank, 1992. vi, 123 p. (World Bank Technical Paper No. 167)The World Bank has complied a report of 7 case studies of successful tropical disease control programs. In Brazil, the Superintendency for Public Health Campaigns plans and implements tropical disease control programs (malaria, yellow fever, schistosomiasis, dengue, plague, and Chagas disease) based on previous campaign results. China operates a large and complex schistosomiasis control program which has a different task and strategy for each of the 3 targeted regions: the plans, hills and mountains, and marshlands and lakes. Egypt manages a schistosomiasis control program which protects 18 million people in 12 governates from the disease at a cost ofAdd to my documents.20073025
Lancet. 1992 May 9; 339(8802):1162-3.HIV infection was detected in India in 1986 in 6 female prostitutes. Current estimates are that 1 million people in India are HIV positive. The official number of AIDS cases to date is 112. In Bombay, Pune, and Madras, 33% of the prostitutes and 50% of the IV drug users have become HIV positive. There have been reports of HIV positive blood donors and new born infants with HIV. To complicate matters, India is currently experiencing a tuberculosis epidemic with 9 million cases and 500,000 deaths annually. India is receiving US$84 million from the World Bank over the next 5 years plus special WHO funding for a national AIDS prevention and control campaign.21070620
Washington, D.C., World Bank, 1991. x, 51 p. (World Bank Technical Paper No. 159)A World Bank report outlines the results of an empirical study. It lists institutional characteristics connected with successful tropical disease control programs, describes their importance, and extracts useful lessons for disease control specialists and managers. The study covers and compares 7 successful tropical disease control programs: the endemic disease program in Brazil; schistosomiasis control programs in China, Egypt, and Zimbabwe; and the malaria, schistosomiasis, and tuberculosis programs in the Philippines. All of these successful programs, as defined by reaching goals over a 10-15 year period, are technology driven. Specifically they establish a relevant technological strategy and package, and use operational research to appropriately adapt it to local conditions. Further they are campaign oriented. The 7 programs steer all features of organization and management to applying technology in the field. Moreover groups of expert staff, rather than administrators, have the authority to decide on technical matters. These programs operate both vertically and horizontally. Further when it comes to planning strategy they are centralized, but when it comes to actual operations and tasks, they are decentralized. Besides they match themselves to the task and not the task to the organization. Successful disease control programs have a realistic idea of what extension activities, e.g., surveillance and health education, is possible in the field. In addition, they work with households rather than the community. All employees are well trained. Program managers use informal and professional means to motivate then which makes the programs productive. The organizational structure of these programs mixes standardization of technical procedures with flexibility in applying rules and regulations, nonmonetary rewards to encourage experience based use of technological packages, a strong sense of public service, and a strong commitment to personal and professional development.22069152
FRONT LINES. 1991 Nov; 16.Indonesia's success in reaching World Health Organization (WHO) universal immunization coverage standards is described as the result of a strong national program with timely, targeted donor support. USAID/Indonesia's Expanded Program for Immunization (EPI) and other USAID bilateral cooperation helped the government of Indonesia in its goal to immunize children against diphtheria, pertussis, tetanus, polio, tuberculosis, and measles by age 1. The initial project was to identify target areas and deliver vaccines against the diseases, strengthen the national immunization organization and infrastructure, and develop the Ministry of Health's capacity to conduct studies and development activities. This EPI project spanned the period 1979-90, and set the stage for continued expansion of Indonesia's immunization program to comply with the full international schedule and range of immunizations of 3 DPT, 3 polio, 1 BCG, and 1 measles inoculation. The number of immunization sites has increased from 55 to include over 5,000 health centers in all provinces, with additional services provided by visiting vaccinators and nurses in most of the 215,000 community-supported integrated health posts. While other contributory factors were at play, program success is at least partially responsible for the 1990 infant mortality rate of 58/1,000 live births compared to 72/1,000 in 1985. Strong national leadership, dedicated health workers and volunteers, and cooperation and funding from UNICEF, the World Bank, Rotary International, and WHO also played crucially positive roles in improving immunization practice in Indonesia.