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[Washington, D.C.], United States Library of Congress, Congressional Research Service, 2007 Oct 26. 18 p. (CRS Report for Congress Order Code RL34246; USAID Development Experience Clearinghouse Doc. ID / Order No. PC-AAB-678)In 2005, TB prevalence rose only in sub-Saharan Africa and eastern Europe. WHO attributes a number of factors to this increase, including weak health systems, low-quality health care, minimal access to health facilities, insufficient staffing and little human resource development, ill-equipped and substandard laboratories, and limited coordination of TB and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) programs. In FY2008, Congress voted to fund U.S. global TB operations at unprecedented levels. The House FY2008 Foreign Operations Appropriations (H.R. 2764) provided $313.5 million for international TB programs and $300 million for a U.S. contribution to the Global Fund to Fight HIV/AIDS, TB, and Malaria (Global Fund). The Senate version of H.R. 2764 included $200 million for U.S. global TB efforts and $340 million for a U.S. contribution to the Global Fund. Both houses included $300 million in FY2008 Labor, HHS, and Education Appropriations (H.R. 3043 and S. 1710) for a U.S. contribution to the Global Fund. S. Rept.110-107 of S. 1710 also suggested that $10 million more than CDC's FY2007 operating plan for TB be provided to improve CDC's efforts to prevent TB and its progression into XDR-TB. No appropriations bills that include funds for TB efforts have been enacted. (excerpt)
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)
Treatment outcome of new pulmonary tuberculosis in Guangzhou, China 1993 -- 2002: A register-based cohort study.
BMC Public Health. 2007 Nov 29; 7:344.Completion of treatment for tuberculosis (TB) is of utmost priority of TB control programs. The aims of this study were to evaluate the treatment outcome of TB cases registered in Guangzhou during the period 1993-2002, and to identify factors associated with treatment success. Two (of eight) districts in Guangzhou were selected randomly as objects of study and their surveillance database was analyzed to assess the treatment outcome and identify factors associated with treatment success for TB cases registered in Guangzhou. Six treatment outcome criteria were assessed based on guidelines set by the World Health Organization (WHO). Logistic regression was used to estimate risk factors for treatment outcome. A total of 6743 pulmonary tuberculosis cases (4903 males, 1840 females) were included in this study. The treatment success rate (including cured and complete treatment) was 88% (95%CI 87%-89%). One hundred and eight-six (2.8%) patients died and 401 (5.9%) patients defaulted treatment. In multivariate analysis, treatment success was found to be associated with young age, lack of cavitation and compliance with treatment. The total treatment success rate in the current study was similar to the WHO target for all smear positive cases, while the failure rate and the default rate in 2002 were slightly higher. Good care of elderly patients, early diagnosis of cavitation and compliance with treatment could improve the success rate of TB treatment. (author's)
Antiretroviral therapy for HIV infection in infants and children: towards universal access. Recommendations for a public health approach.
Geneva, Switzerland, WHO, 2007.  p.These stand-alone treatment guidelines serve as a framework for selecting the most potent and feasible first-line and second-line ARV regimens as components of expanded national responses for the care of HIV-infected infants and children. Recommendations are provided on: diagnosing HIV infection in infants and children; when to start ART, including situations where severe HIV disease in children less than 18 months of age has been presumptively diagnosed; clinical and laboratory monitoring of ART; substitution of ARVs for toxicities. The guidelines consider ART in different situations, e.g. where infants and children are coinfected with HIV and TB or have been exposed to ARVs either for the prevention of MTCT (PMTCT) or because of breastfeeding from an HIV-infected mother on ART. They address the importance of nutrition in the HIV-infected child and of severe malnutrition in relation to the provision of ART. Adherence to therapy and viral resistance to ARVs are both discussed with reference to infants and children. A section on ART in adolescents briefly outlines key issues related to treatment in this age group. (excerpt)
Obstetrics and Gynecology. 2007 Nov; 110(5):999-1002.Family planning plays a pivotal role in population growth, poverty reduction, and human development. Evidence from the United Nations and other governmental and nongovernmental organizations supports this conclusion. Failure to sustain family planning programs, both domestically and abroad, will lead to increased population growth and poorer health worldwide, especially among the poor. However, robust family planning services have a range of benefits, including maternal and infant survival, nutrition, educational attainment, the status of girls and women at home and in society, human immunodeficiency virus (HIV) prevention, and environmental conservation efforts. Family planning is a prerequisite for achievement of the United Nations' Millennium Development Goals and for realizing the human right of reproductive choice. Despite this well-documented need, the U.S. contribution to global family planning has declined in recent years. (author's)
European Journal of Public Health. 2007 Oct; 17(5):409.In public health teaching, tuberculosis (TB) has been a traditional example of how disease occurrence is determined by the triad agent, environment, host. And it has since long been standard textbook knowledge that there are strong socioeconomic determinants behind all three components: The agent is more prevalent and is spread more easily in conditions of crowding and poor hygienic conditions, and under these conditions several host factors are also more prevalent, such as malnutrition and alcoholism. In recent years another dimension has been added to the socioeconomic patterning of TB: An already very solid mass of research has highlighted the social and economic aspects of care and follow-up of patients with TB. A recent example of this research is the paper by Wang et al. in this issue of the journal, on differences in both patient's delay and doctor's delay in the diagnosis of TB, when comparing residents and non-residents (rural immigrants) in Shanghai. (excerpt)
Towards universal access: scaling up priority HIV / AIDS interventions in the health sector. Progress report, April 2007.
Geneva, Switzerland, WHO, 2007 Apr. 88 p.Drawing on lessons from the scale-up of HIV interventions over the last few years, WHO, as the UNAIDS cosponsor responsible for the health sector response to HIV/AIDS, has established priorities for its technical work and support to countries on the basis of the following five Strategic Directions, each of which represents a critical area where the health sector must invest if significant progress is to be made towards achieving universal access. Enabling people to know their HIV status; Maximizing the health sector's contribution to HIV prevention; Accelerating the scale-up of HIV/AIDS treatment and care; Strengthening and expanding health systems; Investing in strategic information to guide a more effective response. In this context, WHO undertook at the World Health Assembly in May 2006 to monitor and evaluate the global health sector response in scaling up towards universal access and to produce annual reports. This first report addresses progress in scaling up the following health sector interventions. Antiretroviral therapy; Prevention of mother-to-child transmission of HIV (PMTCT); HIV testing and counseling; Interventions for injecting drug users (IDUs); Control of sexually transmitted infections (STIs) to prevent HIV transmission; Surveillance of the HIV/AIDS epidemic. (excerpt)
Global Fund-supported programmes' contribution to international targets and the Millennium Development Goals: An initial analysis.
Bulletin of the World Health Organization. 2007 Oct; 85(10):805-811.The Global Fund to Fight AIDS, Tuberculosis and Malaria is one of the largest funders to fight these diseases. This paper discusses the programmatic contribution of Global Fund-supported programmes towards achieving international targets and Millennium Development Goals, using data from Global Fund grants. Results until June 2006 of 333 grants supported by the Global Fund in 127 countries were aggregated and compared against international targets for HIV/AIDS, tuberculosis and malaria. Progress reports to the Global Fund secretariat were used as a basis to calculate results. Service delivery indicators for antiretrovirals (ARV) for HIV/AIDS, case detection under the DOTS strategy for tuberculosis (DOTS) and insecticide-treated nets (ITNs) for malaria prevention were selected to estimate programmatic contributions to international targets for the three diseases. Targets of Global Fund-supported programmes were projected based on proposals for Rounds 1 to 4 and compared to international targets for 2009. Results for Global Fund-supported programmes total 544 000 people on ARV, 1.4 million on DOTS and 11.3 million for ITNs by June 2006. Global Fund-supported programmes contributed 18% of international ARV targets, 29% of DOTS targets and 9% of ITNs in sub-Saharan Africa by mid-2006. Existing Global Fund-supported programmes have agreed targets that are projected to account for 19% of the international target for ARV delivery expected for 2009, 28% of the international target for DOTS and 84% of ITN targets in sub-Saharan Africa. Global Fund-supported programmes have already contributed substantially to international targets by mid-2006, but there is a still significant gap. Considerably greater financial support is needed, particularly for HIV, in order to achieve international targets for 2009. (author's)
Safety of switching to nevirapine-based highly active antiretroviral therapy at elevated CD4 cell counts in a resource-constrained setting [letter]
Journal of Acquired Immune Deficiency Syndromes. 2007 Aug 15; 45(5):598-600.The World Health Organization recommends the use of generic nevirapine (NVP)/efavirenz (EFV)-based highly active antiretroviral therapy (HAART) regimens as first-line therapy in the management of HIV in resource-limited settings. Initiating NVP-based HAART at elevated CD4 cell counts can lead to liver toxicity. Short-term risk of liver toxicity has been reported in men with CD4 counts greater than 400 cells/mL and in women with CD4 counts greater than 250 cells/mL. Hence, clinicians are advised to monitor the results of liver chemistry tests closely in the first 18 weeks of therapy because of the potential to develop life-threatening hepatic events. Mocroft et al showed that initiating NVP therapy at elevated CD4 levels may be safe for use in antiretroviral-experienced patients. Little is known about short-term adverse consequences and clinical outcome at elevated CD4 cell counts in a resource-limited setting. (author's)
Bulletin of the History of Medicine. 2007 Summer; 81(2):407-430.Between 1947 and 1951 the Scandinavian-led International Tuberculosis Campaign tested more than 37 million children and adolescents for tuberculosis, and vaccinated more than 16 million with BCG vaccine. The campaign was an early example of an international health program, and it was generally seen as the largest medical campaign to date. It was born, however, as a Danish effort to create goodwill in war-ravaged Europe, and was extended outside Europe only because UNICEF in 1948 unexpectedly donated US $2 million specifically for BCG vaccination in areas outside Europe. As the campaign transformed from postwar relief to an international health program it was forced to make adaptations to different demographic, social, and cultural contexts. This created a tension between a scientific ideal of uniformity, on the one hand, and pragmatic flexibility on the other. Looking at the campaign in India, which was the most important non-European country in the campaign, this article analyzes three issues in more detail: the development of a simplified vaccination technique; the employment of lay-vaccinators; and whether the campaign in India was conceived as a short-term demonstration or a more extensive mass-vaccination effort. (author's)
Journal of the Indian Medical Association. 2007 Apr; 105(4):198, 212.Tuberculosis has been declared to be a global emergency and the HIV/AIDS is fuelling the epidemic. To contain the disease for its re-emergence a massive funding was earmarked. Widespread implementation of the DOTS strategy specially in countries of high TB burden is a major progress in global TB control. As a sizeable section of TB patients contact a private health provider, so the policy makers of health envisaged the idea for Public-Private Partnership mix model to contain the disease and hence the role of IMA with its two lacs members has definite role to play to stop the menace. The Stop TB strategy is designed to achieve the targets set for the period 2006-2015. Members of IMA have got a life time chance to prove to the people and to the power that they are not lagging behind in providing a service to the nation and there lies the strength of the IMA. (author's)
Bulletin of the World Health Organization. 2007 Aug; 85(8):631-636.Following the destruction of Cambodia's health infrastructure during the Khmer Rouge period (1975-1979) and the subsequent decade of United Nations sanctions, international development assistance has focused on reconstructing the country's health system. The recognition of Cambodia's heavy burden of tuberculosis (TB) and the lapse of TB control strategies during the transition to democracy prompted the national tuberculosis programme's relaunch in the mid-1990s as WHO-backed health sector reforms were introduced. This paper examines the conflicts that arose between health reforms and TB control programmes due to their different operating paradigms. It also discusses how these tensions were resolved during introduction of the DOTS strategy for TB treatment. (author's)
Bulletin of the World Health Organization. 2007 Aug; 85(8):586-592.WHO's new Global Plan to Stop TB 2006-2015 advises countries with a high burden of tuberculosis (TB) to expand case-finding in the private sector as well as services for patients with HIV and multidrug-resistant TB (MDR-TB). The objective of this study was to evaluate these strategies in Thailand using data from the Thailand TB Active Surveillance Network, a demonstration project begun in 2004. In October 2004, we began contacting public and private health-care facilities monthly to record data about people diagnosed with TB, assist with patient care, provide HIV counselling and testing, and obtain sputum samples for culture and susceptibility testing. The catchment area included 3.6 million people in four provinces. We compared results from October 2004-September 2005 (referred to as 2005) to baseline data from October 2002-September 2003 (referred to as 2003). In 2005, we ascertained 5841 TB cases (164/100 000), including 2320 new smear-positive cases (65/100 000). Compared with routine passive surveillance in 2003, active surveillance increased reporting of all TB cases by 19% and of new smear-positive cases by 13%. Private facilities diagnosed 634 (11%) of all TB cases. In 2005, 1392 (24%) cases were known to be HIV positive. The proportion of cases with an unknown HIV status decreased from 66% (3226/4904) in 2003 to 23% (1329/5841) in 2005 (P< 0.01). Of 4656 pulmonary cases, mycobacterial culture was performed in 3024 (65%) and MDR-TB diagnosed in 60 (1%). In Thailand, piloting the new WHO strategy increased case-finding and collaboration with the private sector, and improved HIV services for TB patients and the diagnosis of MDR-TB. Further analysis of treatment outcomes and costs is needed to assess this programme's impact and cost effectiveness. (author's)
Lancet. 2007 Jul 28; 370(9584):311.In 1983, Michel Kazatchkine was a clinical immunologist at the Hôpital Broussais in Paris, France, when he was called to see a French couple with unexplained fever and severe immune deficiency who had been airlifted home from Africa. This man and woman were the first of many AIDS patients that Kazatchkine would take care of in the coming decades. There were no effective antiretroviral treatments available, and the couple lived only a few months on the ward before dying. "Those were difficult years with patients dying every day on the wards", Kazatchkine recalls. Much of his time, he says, was spent providing end-of-life care, consoling patients, "and holding their hands when they were dying". This year, after more than two decades of working in AIDS clinical care, research, and international programmes, Kazatchkine takes over the helm of the second largest funder of AIDS care: the Global Fund to Fight AIDS, Tuberculosis & Malaria. Anthony Fauci, Director of the US National Institute of Allergy andInfectious Disease, who says he has worked "up close and personal" with Kazatchkine since the early days of the epidemic, calls him "the perfect kind of person for the position". He's a scientist who understands the science; a clinician who understands clinical care; and an expert in AIDS who understands the epidemic, Fauci says. "He's also a fine 'people person': the kind of person who can build consensus, but also the kind of person who can take the lead." (excerpt)
Lancet. 2007 Jul 28; 370(9584):307-308.This spring the Global Fund to Fight AIDS, Tuberculosis and Malaria announced that its programmes had treated nearly 3 million tuberculosis patients, distributed more than 30 million insecticide-treated bednets, and were providing antiretroviral drugs to more than 1 million people infected with HIV. After nearly 5 years of operation "Global Fund programmes are saving 3000 lives a day", says the Fund's new executive director Michel Kazatchkine. The Fund was launched in 2002 to raise, manage, and disburse funds to fight three leading killers of people in poor countries: HIV/AIDS, tuberculosis, and malaria. At the time, efforts to combat those diseases were fragmented and woefully underfunded. The Fund's narrow focus has won it the approval of foreign-aid sceptics such as William Easterly, professor of economics at New York University in New York City and author of the book White Man's Burden, which critiques many current development programmes. "One of the curses of foreign aid is that each agency tries to do everything; and when you try to do everything, you tend to do a mediocre or bad job", Easterly says. (excerpt)
Treatment strategies for HIV-infected patients with tuberculosis: Ongoing and planned clinical trials.
Journal of Infectious Diseases. 2007 Aug 15; 196 Suppl 1:S46-S51.Currently, there are limited data to guide the management of highly active antiretroviral therapy (HAART) for human immunodeficiency virus type 1 (HIV-1)-infected patients with active tuberculosis (TB), the leading cause of death among individuals with acquired immunodeficiency syndrome (AIDS) in resource-limited areas. Four trials to take place in Southeast Asian, African, and South American countries will address the unresolved question of the optimal timing for initiation of HAART in patients with AIDS and TB: (1) Cambodian Early versus Late Introduction of Antiretrovirals (CAMELIA [ANRS 1295/NIH-CIPRA KH001]), (2) Adult AIDS Clinical Trials Group A5221, (3) START, and (4) a trial sponsored by the World Health Organization/Special Programme for Research and Training in Tropical Diseases. Two other clinical questions regarding patients with TB and HIV-1 coinfection are also undergoing evaluation: (1) the benefits of short-term HAART when CD4 cell counts are > 350 cells/mm3 (PART [NIH 1 R01 AI051219-01A2]) and (2) the efficacy of a once-daily HAART regimen in treatment-naive patients (BKVIR [ANRS 129]). Here, we present an overview of these ongoing or planned clinical studies, which are supported by international agencies. (author's)
Journal of Infectious Diseases. 2007 Aug 15; 196 Suppl 1:S5-S14.Tuberculosis (TB) and human immunodeficiency virus (HIV) infection make each other's control significantly more difficult. Coordination in addressing this "cursed duet" is insufficient at both global and national levels. However, global policy for TB/HIV coordination has been set, and there is consensus around this policy from both the TB and HIV control communities. The policy aims to provide all necessary care for the prevention and management of HIV-associated TB, but its implementation is hindered by real technical difficulties and shortages of resources. All major global-level institutions involved in HIV care and prevention must include TB control as part of their corporate policy. Country-level decision makers need to work together to expand both TB and HIV services, and civil society and community representatives need to hold those responsible accountable for their delivery. The TB and HIV communities should join forces to address the health-sector weaknesses that confront them both. (author's)
Journal of Infectious Diseases. 2007 Aug; 196 Suppl 1:S4-.This supplement to the Journal of Infectious Diseases on tuberculosis (TB)/HIV coinfection came together as a result of a collaboration between the National Institutes of Health (NIH)-funded Centers for AIDS Research (CFARs) at Harvard University and at the University of Pennsylvania, and the Forum for Collaborative HIV Research. It is based on 2 programs addressing TB/HIV coinfection research challenges. A steering committee, consisting of Bruce Walker, Edward Nardell, Megan Murray, and Eric Rubin (Harvard University); Gerald Friedland (Yale University); and James Hoxie (University of Pennsylvania); with the support of the national network of CFARs, organized a symposium entitled "Confronting TB/HIV Co-infection" that was held on 30 June 2005 at Harvard University. The Forum for Collaborative HIV Research, together with the International AIDS Society and the Agence National de Recherches sur le Sida et les Hepatites Virales, with special support from Tibotec, sponsored a special session entitled "HIV/TB: New Visions, New Directions" during the 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment in Rio de Janeiro on 25 July 2005, followed by a roundtable discussion with representatives from the World Health Organization HIV/ AIDS and Stop TB departments; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the NIH; the Centers for Disease Control and Prevention (CDC); and leaders from the pharmaceutical industry, research networks, and advocacy organizations. (excerpt)
The evolving cost of HIV in South Africa: Changes in health care cost with duration on antiretroviral therapy for public sector patients.
Journal of Acquired Immune Deficiency Syndromes. 2007 Jul; 45(3):348-354.A retrospective costing study of 212 patients enrolled in a nongovernmental organization-supported public sector antiretroviral treatment (ART) program near Cape Town, South Africa was performed from a health care system perspective. t-Regression was used to analyze total costs in 3 periods: Pre-ART (median length = 30 days), first 48 weeks on ART (Year One), and 49 to 112 weeks on ART (Year Two). Average cost per patient Pre-ART was $404. Average cost per patient-year of observation was $2502 in Year One and $1372 in Year Two. The proportion of costs attributable to hospital care fell from 70% Pre-ART to 24% by Year Two; the proportion attributable to ART rose from 31% in Year One to 55% in Year Two. In multivariate analysis, Pre-ART and Year One costs were significantly lower for asymptomatic patients compared with those with AIDS. Costs were significantly higher for those who died Pre-ART or in Year One. In Year Two, only week 48 CD4 cell count and being male were significantly associated with lower costs. This analysis suggests that the total cost of treatment for patients on ART falls by almost half after 1 year, largely attributable to a reduction in hospital costs. (author's)
A research agenda for childhood tuberculosis. Improving the management of childhood tuberculosis within national tuberculosis programmes: research priorities based on a literature review.
Geneva, Switzerland, World Health Organization [WHO], 2007.  p. (WHO/HTM/TB/2007.381; WHO/FCH/CAH/07.02)Childhood TB is a neglected aspect of the TB epidemic, despite constituting 20% or more of the TB case-load in many countries with high TB incidence. This "orphan disease" exists in the shadow of adult TB and is a significant child health problem, but is neglected because it is usually smear-negative and is thus considered to make a relatively minor contribution to the spread of TB. In order to redress this neglect and integrate childhood TB into the mainstream of TB control activities, research priorities are identified that will assist in improving the prevention and management of childhood TB as a part of national TB programmes (NTPs). The proposed research agenda seeks to better define childhood TB, to optimize the treatment of childhood TB and to identify the best management practices by which childhood TB can be accurately documented and recorded, and efficiently managed within NTPs. (excerpt)
Public-private mix for TB care and control. Focus on Africa. Report of the fourth meeting of the Subgroup on Public-Private Mix for TB Care and Control, 12-14 September 2006, Nairobi, Kenya.
Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2007. 27 p. (WHO/HTM/TB/2007.378)The Subgroup on Public-Private Mix for DOTS Expansion (PPM Subgroup) was established by the global Stop TB Partnership's DOTS Expansion Working Group (DEWG) to help promote and facilitate active engagement of all relevant public and private health care providers in TB control. The members of the Subgroup include representatives from the private sector, academia, country TB programme managers, policy-makers, field experts working on the issue, international technical partners and donor agencies. At the first meeting of the Subgroup in November 2002, generic regional and national Public-Private Mix (PPM) strategies were developed and endorsed. The Subgroup's second meeting, which was held at the WHO Regional Office for South-East Asia in New Delhi in February 2004, reviewed the growing evidence base emerging from numerous PPM initiatives. This meeting also broadened the scope of PPM to include the involvement of public sector providers not yet linked to national tuberculosis programmes (NTPs). Consequently, PPM has since stood for the engagement of all public and private health care providers through public-private, public-public and private-private collaboration in TB control. The third meeting of the Subgroup, held in Manila in April 2005, identified barriers and enablers for scaling up and sustaining PPM, and discussed how to mainstream PPM into regular TB control planning and implementation. The Subgroup's current fourth meeting in Nairobi, Kenya, in September 2006 had PPM for TB control in Africa as the main focus. The problems related to the HIV epidemic, human resources for health and health sector reforms pose special challenges to countries in Africa. The meeting examined how successful PPM approaches within Africa could be scaled up and how approaches applied in other regions could be adapted to African settings. Based on a global overview, the African experience in diverse country settings and field visits to examine working PPM models and after a great deal of deliberations and discussions, the Subgroup made recommendations which are presented in Section 6 of the report. A large part of the funding for the meeting was provided by USAID's Tuberculosis Control Assistance Program (TB CAP). (excerpt)
Lancet. 2007 May 26; 369(9575):1768-1769.In today's Lancet, Steven Radelet and Bilal Siddiqi examine the associations between evaluation scores assigned by the Global Fund to Fight AIDS, Tuberculosis and Malaria to recipient countries and characteristics of grants and countries. This analysis complements a previous look at the capacity of recipient countries to disburse Global Fund money. The selection of the outcome variable-grant scores and disbursement rates-differed, but both analyses included several common programmatic and country-specific variables. Both studies found that poor countries are not disadvantaged compared with middle-income recipients in terms of performance. The fundamental question for both studies, however, is what does the selected outcome variable measure. Grant performance scores from the Global Fund have several limitations. First, the recipients define the numerical targets for each quarter for the progress indicators. The scores do not allow for comparisons of progress across recipients compared with baseline. An A recipient has not necessarily increased coverage of key interventions more than a B1 recipient. Category A represents grants reaching or exceeding expectations, whereas B1 covers grants that have adequate performance. Second, validation of reported progress against programmatic benchmarks is inherently difficult in countries with weak health-information systems. Progress on delivery of interventions has not been assessed with population-based measurements of the delivery of the interventions funded by the grants, but rather on more upstream processes or provider-based data-collection mechanisms. Third, the evaluation process is not entirely independent and includes progress monitoring by local agents selected by the Fund. (excerpt)
Journal of Tropical Pediatrics. 2007 Jun; 53(3):147-149.Tuberculosis (TB) kills about 2 million adults and around 100 000 children every year. One-third of the world's population are currently infected with Mycobacterium tuberculosis and many have active disease. In Europe TB emerged as a major disease in the latter part of the 14th century. The industrial revolution saw rapid growth of urban centres where overcrowding with poor living conditions provided ideal circumstances for the spread of the disease. Great impact was made by streptomycin and isoniazid, so that by the 1970s TB was no longer being considered a problem in the developed world. But beginning in the 1980s the number of new cases of TB in USA and across Europe rose sharply. The pattern was repeated in many countries and worldwide throughout the 1990s and into the new millennium. The incidence of TB climbed to over 9 million cases every year. In 1993 the World Health Organization (WHO) declared TB as a global emergency. During the 1990s multidrug resistant tuberculosis (MDR-TB), defined as resistance to at least isoniazid and rifampicin, emerged as a threat to TB control. MDR-TB requires the use of second line drugs that are less effective, more toxic and costlier. In a global survey of 17 690 TB isolates during 2000-04, 20% were MDR and 2% were extremely drug resistant (XDR). XDR-TB is defined as MDR plus resistance to any fluoroquinolones and at least one of three injectable second line drugs kanamycin and amikacin, or capreomycin or both. Currently one in ten new infections is resistant to at least one antituberculosis drug. (excerpt)
Tuberculosis. Testimony of Dr. Kent R. Hill, Assistant Administrator for Global Health, U.S. Agency for International Development, before the Subcommittee on Africa and Global Health, Committee on Foreign Affairs, U.S. House of Representatives, March 21, 2007.
[Unpublished] 2007.  p. (USAID Development Experience Clearinghouse DocID / Order No. PD-ACJ-067)I know we are here to talk about Africa - where the TB problem is indeed severe -- but it is also important and relevant to keep in mind the global TB situation. Sixty percent of the global burden of TB is in the Asia and the Western Pacific regions - notably in countries such as India, China, Indonesia, Bangladesh, Pakistan, The Philippines, Viet Nam, and Cambodia. While many of these countries have made tremendous progress in recent years, there is still much more that needs to be done to ensure sustainability. In Latin America, while there has been much success in controlling TB, sustaining that progress will require TB services reaching the poorest and marginalized groups in all countries. We also can not forget Eastern Europe and Eurasia, where gaining commitment to internationally recognized TB control standards continues to be an uphill struggle. While the recent outbreak of XDR TB in South Africa has made the headlines and must be urgently and effectively dealt with, 17 of the 21 priority countries identified in the WHO's Global MDR and XDR TB response plan are in Asia and the Western Pacific. We must increase attention to Africa, but we can not overlook the other regions where TB is still a serious problem and where MDR and XDR TB are a looming threat. Between 2000 and 2006, USAID provided about $500 million for TB programs worldwide. Our FY 2006 funding level was about $90 million which supported bilateral TB programs in 37 countries (of which 19 are USAID high priority TB countries), as well as other key activities including global surveillance and research on new anti-TB drugs and diagnostics. In FY 2006, USAID provided $5 million to the STOP TB Partnership's Global TB Drug Facility (GDF), an important mechanism that provides drugs to countries in need. Our programs are fully aligned with the new STOP TB Strategy, which builds on the WHO recommended "Directly Observed Treatment, Shortcourse" or DOTS by giving attention to DOTS quality and as well as expansion, TB/HIV-AIDS and MDR TB, engaging all care providers, empowering people with TB and communities, contributing to health system strengthening, and research. (excerpt)
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.In 1991, the 44th World Health Assembly set two key targets for global tuberculosis (TB) control to be reached by 2000: 70% case detection of acid-fast bacilli smear-positive TB patients under the DOTS strategy recommended by WHO and 85% treatment success of those detected. This paper describes how TB control was scaled up to achieve these targets; it also considers the barriers encountered in reaching the targets, with a particular focus on how HIV infection affects TB control. Strong TB control will be facilitated by scaling-up WHO-recommended TB/HIV collaborative activities and by improving coordination between HIV and TB control programmes; in particular, to ensure control of drug-resistant TB. Required activities include more HIV counselling and testing of TB patients, greater use and acceptance of isoniazid as a preventive treatment in HIV-infected individuals, screening for active TB in HIV-care settings, and provision of universal access to antiretroviral treatment for all HIV-infected individuals eligible for such treatment. Integration of TB and HIV services in all facilities (i.e. in HIV-care settings and in TB clinics), especially at the periphery, is needed to effectively treat those infected with both diseases, to prolong their survival and to maximize limited human resources. Global TB targets can be met, particularly if there is renewed attention to TB/HIV collaborative activities combined with tremendous political commitment and will. (author's)