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Kumar AM, Harries AD, Satyanarayana S, Thekkur P, Shewade HD, Zachariah R. What is operational research and how can national tuberculosis programmes in low- and middle-income countries use it to end TB? Indian J Tuberc 2020; 67:S23-S32. [PMID: 33308668 DOI: 10.1016/j.ijtb.2020.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022]
Abstract
Despite considerable progress over the years, tuberculosis (TB) still remains the top cause of death among the infectious diseases and has devastating socio-economic consequences for people in low- and middle-income countries. To add to this, the emergence of the COVID-19 pandemic has worsened delivery of TB care across the globe. As a global community, we have committed to end the TB epidemic by 2030. The World Health Organization has framed a strategy to achieve this goal which consists of three pillars namely i) integrated patient-centred care and prevention, ii) bold policies and systems and iii) intensified research and innovation. An analysis of the performance of national tuberculosis programmes (NTPs) across the globe against the ten priority indicators recommended for monitoring the end TB strategy show that there are huge gaps at every step in the cascade of care of TB patients. In our view, these gaps reflect suboptimal implementation of existing strategies known to be efficacious and operational research (OR) is one of the best available tools to plug the gaps. In this paper, we define what operational research is and how it differs from other kinds of research. We also share our views and experiences about how operational research can be used by NTPs to identify implementation gaps and their reasons, and develop and test possible solutions - which are then integrated to make changes to policy and practice and eventually improve programme outcomes. OR can be defined as research into interventions, strategies and tools which produces practical useable knowledge that can be used to enhance the quality, coverage, effectiveness and efficiency of disease control programmes, health services or health systems in which the research is conducted. The key steps in integrating operational research in the NTPs include: i) securing political commitment reflected by inclusion of OR in the national strategic plans of NTPs and earmarked funding, ii) having a critical mass of dedicated and trained human resources in OR within the NTP, iii) setting research priorities and steering the direction of research in the country, iv) using output-oriented models of capacity building such as the Structured Operational Research Training Initiative (SORT IT) model and building communities of practice, v) harnessing existing capacity in the country by forging partnerships with academia, vi) NTP-led nationwide, multicentre OR studies, vii) providing access to anonymized patient and programme surveillance data, vii) creating a forum for evidence dissemination and fostering policy change and ix) monitoring and accountability. In conclusion, ending the TB epidemic will not be possible without new tools (diagnostics, drugs, vaccines) and a multi-sectoral response involving stakeholders beyond the health ministry, including private providers, patients and communities. However, timely conduct of operational research to fine-tune programme implementation and ensuring proper deployment of new tools will be equally crucial to maximize the effectiveness and efficiency of interventions and ultimately contribute towards ending TB.
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Affiliation(s)
- Ajay Mv Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India; Yenepoya Medical College, Yenepoya (Deemed to Be University), Mangalore, India.
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; London School of Hygiene and Tropical Medicine, London, UK
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India
| | - Hemant D Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India
| | - Rony Zachariah
- Special Programme for Research and Training in Tropical Disease (TDR), World Health Organization, Geneva, Switzerland
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Morishita F, Yamanaka T, Islam T. Intensified research on tuberculosis in the Western Pacific Region: a bibliometric analysis, 2000-2019. Western Pac Surveill Response J 2020; 11:24-31. [PMID: 34046238 PMCID: PMC8152822 DOI: 10.5365/wpsar.2020.11.3.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
"Intensified TB research and innovation" is one of the three pillars of the End TB Strategy. To assess achievements and gaps in tuberculosis (TB) research productivity in countries and areas of the Western Pacific Region quantitatively, a bibliometric analysis was carried out by examining trends in the numbers of publications on TB indexed in PubMed between 2000 and 2019 and by comparing them with trends in publications on other selected major infectious diseases for the same period. The number of publications on TB in the Region increased by 3.2 times during the period, from 534 in 2000-2004 to 1714 in 2015-2019, as compared with 2.9 times each for HIV, hepatitis and malaria. The number increased by 46% in 2005-2009, 79% in 2010-2014 and 23% in 2015-2019, as compared with each previous 5-year period. The average annual growth rate between 2000 and 2018 was 8.8%. China accounted for 34.8% of the total number of publications on TB in the Region. Increases in TB research were observed in most countries and areas in the Region, particularly in those with a high TB burden. The number of publications on TB remained low, however, in the Lao People's Democratic Republic, Mongolia and Pacific island countries. Countries are encouraged to implement the set of actions proposed in the Global Strategy for TB Research and Innovation to accelerate progress towards ending TB.
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Affiliation(s)
- Fukushi Morishita
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Takuya Yamanaka
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom of Great Britain and Northern Ireland
| | - Tauhid Islam
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
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Harries AD, Kumar AMV, Satyanarayana S, Thekkur P, Lin Y, Dlodlo RA, Zachariah R. How Can Operational Research Help to Eliminate Tuberculosis in the Asia Pacific Region? Trop Med Infect Dis 2019; 4:E47. [PMID: 30875884 PMCID: PMC6473929 DOI: 10.3390/tropicalmed4010047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 01/10/2023] Open
Abstract
Broad multi-sectoral action is required to end the tuberculosis (TB) epidemic by 2030 and this includes National TB Programmes (NTPs) fully delivering on quality-assured diagnostic, treatment and preventive services. Large implementation gaps currently exist in the delivery of these services, which can be addressed and closed through the discipline of operational research. This paper outlines the TB disease burden and disease-control programme implementation gaps in the Asia-Pacific region; discusses the key priority areas in diagnosis, treatment and prevention where operational research can be used to make a difference; and finally provides guidance about how best to embed operational research within a TB programme setting. Achieving internationally agreed milestones and targets for case finding and treatment requires the NTP to be streamlined and efficient in the delivery of its services, and operational research provides the necessary evidence-based knowledge and support to allow this to happen.
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Affiliation(s)
- Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France.
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Ajay M V Kumar
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France.
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India.
- Yenepoya Medical College, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore 575018, India.
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France.
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India.
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France.
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India.
| | - Yan Lin
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France.
- International Union Against Tuberculosis and Lung Disease, No.1 Xindong Road, Beijing 100600, China.
| | - Riitta A Dlodlo
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France.
| | - Rony Zachariah
- Special Programme for Research and Training in Tropical Disease (TDR), World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.
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Harries AD, Lin Y, Kumar AMV, Satyanarayana S, Takarinda KC, Dlodlo RA, Zachariah R, Olliaro P. What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030? F1000Res 2018; 7. [PMID: 30026917 PMCID: PMC6039935 DOI: 10.12688/f1000research.14821.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2018] [Indexed: 12/27/2022] Open
Abstract
The international community has committed to ending the tuberculosis (TB) epidemic by 2030. This will require multi-sectoral action with a focus on accelerating socio-economic development, developing and implementing new tools, and expanding health insurance coverage. Within this broad framework, National TB Programmes (NTPs) are accountable for delivering diagnostic, treatment, and preventive services. There are large gaps in the delivery of these services, and the aim of this article is to review the crucial activities and interventions that NTPs must implement in order to meet global targets and milestones that will end the TB epidemic. The key deliverables are the following: turn End TB targets and milestones into national measurable indicators to make it easier to track progress; optimize the prompt and accurate diagnosis of all types of TB; provide rapid, complete, and effective treatment to all those diagnosed with TB; implement and monitor effective infection control practices; diagnose and treat drug-resistant TB, associated HIV infection, and diabetes mellitus; design and implement active case finding strategies for high-risk groups and link them to the treatment of latent TB infection; engage with the private-for-profit sector; and empower the Central Unit of the NTP particularly in relation to data-driven supportive supervision, operational research, and sustained financing. The glaring gaps in the delivery of TB services must be remedied, and some of these gaps will require new paradigms and ways of working which include patient-centered and higher-quality services. There must also be fast-track ways of incorporating new diagnostic, treatment, and prevention tools into program activities so as to rapidly reduce TB incidence and mortality and meet the goal of ending TB by 2030.
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Affiliation(s)
- Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France.,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Yan Lin
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France.,International Union Against Tuberculosis and Lung Disease, No. 1 Xindong Road, 100600 Beijing, China
| | - Ajay M V Kumar
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France.,International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, C-6 Qutub Institutional Area, 110016 New Delhi, India
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France.,International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, C-6 Qutub Institutional Area, 110016 New Delhi, India
| | - Kudakwashe C Takarinda
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France.,AIDS & TB Department, Ministry of Health and Child Care, 2nd Floor, Mukwati Building, Corner Livingstone Avenue and 5th Street, Harare, Zimbabwe
| | - Riitta A Dlodlo
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France
| | - Rony Zachariah
- Special Programme for Research and Training in Tropical Disease (TDR), World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Piero Olliaro
- Special Programme for Research and Training in Tropical Disease (TDR), World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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