Investing to end epidemics: the role of the Global Fund to control TB by 2030

Kunii, Osamu; Yassin, Mohammed A.; Wandwalo, Eliud

doi:10.1093/trstmh/trw005

Cited by 7 publications

(6 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A key reason for this slow rate of decline is the "detection gap", defined as the 3-4 million TB patients unreached by national TB control programs (NTP) each year [8]. This gap continues to cause avoidable deaths and fuel transmission of TB [9].…”

Section: Introductionmentioning

confidence: 99%

Evaluating the yield of systematic screening for tuberculosis among three priority groups in Ho Chi Minh City, Viet Nam

Vo¹,

Codlin²,

Forse³

et al. 2020

Infect Dis Poverty

View full text Add to dashboard Cite

Background In order to end tuberculosis (TB), it is necessary to expand coverage of TB care services, including systematic screening initiatives. However, more evidence is needed for groups among whom systematic screening is only conditionally recommended by the World Health Organization. This study evaluated concurrent screening in multiple target groups using community health workers (CHW). Methods In our two-year intervention study lasting from October 2017 to September 2019, CHWs in six districts of Ho Chi Minh City, Viet Nam verbally screened three urban priority groups: (1) household TB contacts; (2) close TB contacts; and (3) residents of urban priority areas without clear documented exposure to TB including hotspots, boarding homes and urban slums. Eligible persons were referred for further screening with chest radiography and follow-on testing with the Xpert MTB/RIF assay. Symptomatic individuals with normal or without radiography results were tested on smear microscopy. We described the TB care cascade and characteristics for each priority group, and calculated yield and number needed to screen. Subsequently, we fitted a mixed-effect logistic regression to identify the association of these target groups and secondary patient covariates with TB treatment initiation. Results We verbally screened 321 020 people including 24 232 household contacts, 3182 social and close contacts and 293 606 residents of urban priority areas. This resulted in 1138 persons treated for TB, of whom 85 were household contacts, 39 were close contacts and 1014 belonged to urban priority area residents. The yield of active TB in these groups was 351, 1226 and 345 per 100 000, respectively, corresponding to numbers needed to screen of 285, 82 and 290. The fitted model showed that close contacts [adjusted odds ratio (aOR) = 2.07; 95% CI: 1.38–3.11; P < 0.001] and urban priority area residents (aOR = 2.18; 95% CI: 1.69–2.79; P < 0.001) had a greater risk of active TB than household contacts. Conclusions The study detected a large number of unreached persons with TB, but most of them were not among persons in contact with an index patient. Therefore, while programs should continue to optimize screening in contacts, to close the detection gap in high TB burden settings such as Viet Nam, coverage must be expanded to persons without documented exposure such as residents in hotspots, boarding homes and urban slums.

show abstract

Section: Introductionmentioning

confidence: 99%

Evaluating the yield of systematic screening for tuberculosis among three priority groups in Ho Chi Minh City, Viet Nam

Vo¹,

Codlin²,

Forse³

et al. 2020

Infect Dis Poverty

View full text Add to dashboard Cite

show abstract

“…We recently described TB maintenance as a cause of mortality among PLWHA nationwide 11 . This infection remains one of the most important causes of death among PLWHA across the globe, especially in developing regions 18 , having a major impact on the survival of patients with HIV in Brazil as a whole 19 and even more notably in Rio de Janeiro 20 .…”

Section: Discussionmentioning

confidence: 99%

Perfis de mortalidade em pessoas vivendo com HIV/aids: comparação entre o Rio de Janeiro e as demais unidades da federação entre 1999 e 2015

Paula

Pires

Filho

et al. 2020

Rev. bras. epidemiol.

View full text Add to dashboard Cite

Introduction: The trend toward stabilization regarding the AIDS epidemic in Brazil over the past decade hides a very complex scenario, where two-thirds of the Brazilian federative units exhibit AIDS standardized mortality rates (ASMR) significantly above the national average and/or in upward tendency. ASMR in Rio de Janeiro State remains virtually unchanged over the years; the state currently occupies the second position in the national ranking of this indicator. Objective: To assess temporal trends in causes of death searching for differential profiles that could be useful for understanding mortality among patients with HIV in the state. Methodology: Causes of death were analyzed in any field of the death certificates from the Mortality Information System between 1999 and 2015 for individuals ≥ 15 years of age. Cardiovascular diseases, non-AIDS-related cancers, external causes, diabetes mellitus, and tuberculosis were established by the mention or not of their codes according to the 10 th edition of International Statistical Classification of Diseases and Related Health Problems (ICD-10) in death certificates. Generalized linear mixed-effects models were used to describe odds ratios in relation to 1999 and adjusted mean annual variations. Results: The results point to the emerging role of external causes and genitourinary diseases and the persistent role played by tuberculosis, differentially affecting AIDS mortality in the state, in a scenario of high mortality due to infectious diseases. Conclusion: These data suggest that tuberculosis remains a major cause of death among people living with HIV/AIDS (PLWHA) in Rio de Janeiro, highlighting the need for studies that identify individual-level factors impacting their survival, thus improving local HIV/AIDS control measures.

show abstract

“…The Global Fund is a financier, rather than an implementing/development agency. Along with other global health initiatives created in the early 2000s, it was designed to overcome market and public failures in international public health, as well as disperse the power of the UN and its agencies [ 46 – 48 ]. It was meant to offer streamlined, less bureaucratic, processes.…”

Section: Discussionmentioning

confidence: 99%

The Global Fund’s paradigm of oversight, monitoring, and results in Mozambique

et al. 2017

View full text Add to dashboard Cite

BackgroundThe Global Fund is one of the largest actors in global health. In 2015 the Global Fund was credited with disbursing close to 10 % of all development assistance for health. In 2011 it began a reform process in response to internal reviews following allegations of recipients’ misuse of funds. Reforms have focused on grant application processes thus far while the core structures and paradigm have remained intact. We report results of discussions with key stakeholders on the Global Fund, its paradigm of oversight, monitoring, and results in Mozambique.MethodsWe conducted 38 semi-structured in-depth interviews in Maputo, Mozambique and members of the Global Fund Board and Secretariat in Switzerland. In-country stakeholders were representatives from Global Fund country structures (eg. Principle Recipient), the Ministry of Health, health or development attachés bilateral and multilateral agencies, consultants, and the NGO coordinating body. Thematic coding revealed concerns about the combination of weak country oversight with stringent and cumbersome requirements for monitoring and evaluation linked to performance-based financing.ResultsAnalysis revealed that despite the changes associated with the New Funding Model, respondents in both Maputo and Geneva firmly believe challenges remain in Global Fund’s structure and paradigm. The lack of a country office has many negative downstream effects including reliance on in-country partners and ineffective coordination. Due to weak managerial and absorptive capacity, more oversight is required than is afforded by country team visits. In-country partners provide much needed support for Global Fund recipients, but roles, responsibilities, and accountability must be clearly defined for a successful long-term partnership. Furthermore, decision-makers in Geneva recognize in-country coordination as vital to successful implementation, and partners welcome increased Global Fund engagement.ConclusionsTo date, there are no institutional requirements for formalized coordination, and the Global Fund has no consistent representation in Mozambique’s in-country coordination groups. The Global Fund should adapt grant implementation and monitoring procedures to the specific local realities that would be illuminated by more formalized coordination.Electronic supplementary materialThe online version of this article (10.1186/s12992-017-0308-7) contains supplementary material, which is available to authorized users.

show abstract

Investing to end epidemics: the role of the Global Fund to control TB by 2030

Cited by 7 publications

References 2 publications

Evaluating the yield of systematic screening for tuberculosis among three priority groups in Ho Chi Minh City, Viet Nam

Evaluating the yield of systematic screening for tuberculosis among three priority groups in Ho Chi Minh City, Viet Nam

Perfis de mortalidade em pessoas vivendo com HIV/aids: comparação entre o Rio de Janeiro e as demais unidades da federação entre 1999 e 2015

The Global Fund’s paradigm of oversight, monitoring, and results in Mozambique

Contact Info

Product

Resources

About