In 2009, the International Union Against Tuberculosis and Lung Disease (The Union) and Médecins sans Frontières Brussels-Luxembourg (MSF) began developing an outcome-oriented model for operational research training. In January 2013, The Union and MSF joined with the Special Programme for Research and Training in Tropical Diseases (TDR) at the World Health Organization (WHO) to form an initiative called the Structured Operational Research and Training Initiative (SORT IT). This integrates the training of public health programme staff with the conduct of operational research prioritised by their programme. SORT IT programmes consist of three one-week workshops over 9 months, with clearly-defined milestones and expected output. This paper describes the vision, objectives and structure of SORT IT programmes, including selection criteria for applicants, the research projects that can be undertaken within the time frame, the programme structure and milestones, mentorship, the monitoring and evaluation of the programmes and what happens beyond the programme in terms of further research, publications and the setting up of additional training programmes. There is a growing national and international need for operational research and related capacity building in public health. SORT IT aims to meet this need by advocating for the output-based model of operational research training for public health programme staff described here. It also aims to secure sustainable funding to expand training at a global and national level. Finally, it could act as an observatory to monitor and evaluate operational research in public health. Criteria for prospective partners wishing to join SORT IT have been drawn up.

BackgroundTB is one of the main health priorities in Uzbekistan and relatively high rates of unfavorable treatment outcomes have recently been reported. This requires closer analysis to explain the reasons and recommend interventions to improve the situation. Thus, by using countrywide data this study sought to determine trends in unfavorable outcomes (lost-to-follow-ups, deaths and treatment failures) and describe their associations with socio-demographic and clinical factors.MethodA countrywide retrospective cohort study of all new and previously treated TB patients registered in the National Tuberculosis programme between January 2006 and December 2010.ResultsAmong 107,380 registered patients, 67% were adults, with smaller proportions of children (10%), adolescents (4%) and elderly patients (19%). Sixty per cent were male, 66% lived in rural areas, 1% were HIV-infected and 1% had a history of imprisonment. Pulmonary TB (PTB) was present in 77%, of which 43% were smear-positive and 53% were smear-negative. Overall, 83% of patients were successfully treated, 6% died, 6% were lost-to-follow-up, 3% failed treatment and 2% transferred out. Factors associated with death included being above 55 years of age, HIV-positive, sputum smear positive, previously treated, jobless and living in certain provinces. Factors associated with lost-to-follow-up were being male, previously treated, jobless, living in an urban area, and living in certain provinces. Having smear-positive PTB, being an adolescent, being urban population, being HIV-negative, previously treated, jobless and residing in particular provinces were associated with treatment failure.ConclusionOverall, 83% treatment success rate was achieved. However, our study findings highlight the need to improve TB services for certain vulnerable groups and in specific areas of the country. They also emphasize the need to develop unified monitoring and evaluation tools for drug-susceptible and drug-resistant TB, and call for better TB surveillance and coordination between provinces and neighbouring countries.

The words 'defaulter', 'suspect' and 'control' have been part of the language of tuberculosis (TB) services for many decades, and they continue to be used in international guidelines and in published literature. From a patient perspective, it is our opinion that these terms are at best inappropriate, coercive and disempowering, and at worst they could be perceived as judgmental and criminalising, tending to place the blame of the disease or responsibility for adverse treatment outcomes on one side-that of the patients. In this article, which brings together a wide range of authors and institutions from Africa, Asia, Latin America, Europe and the Pacific, we discuss the use of the words 'defaulter', 'suspect' and 'control' and argue why it is detrimental to continue using them in the context of TB. We propose that 'defaulter' be replaced with 'person lost to follow-up'; that 'TB suspect' be replaced by 'person with presumptive TB' or 'person to be evaluated for TB'; and that the term 'control' be replaced with 'prevention and care' or simply deleted. These terms are non-judgmental and patient-centred. We appeal to the global Stop TB Partnership to lead discussions on this issue and to make concrete steps towards changing the current paradigm.

International Union Against Tuberculosis and Lung DiseaseHealth solutions for the poor C hronic non-communicable diseases have emerged as the next twenty-first century global epidemic and have already become the leading causes of death and disability worldwide. 1 Among these, the global burden of diabetes mellitus (DM) is immense. In 2013, an estimated 382 million people were living globally with DM, with numbers expected to rise to 592 million by 2030. 2 Most of these persons have type 2 DM, and given the association between DM and unhealthy lifestyles, such as poor diet and physical inactivity, there are more people with DM in urban than in rural areas; this divide is estimated to reach 314 million and 143 million, respectively, in 2030. In 2013, DM-related complications were a major cause of disability and reduced quality of life, and an estimated 5 million people aged 20-79 years worldwide died prematurely from the disease. 2 Although Asia is the epicentre of the DM pandemic, there is an increasing burden of disease in sub-Saharan African countries. 3 A systematic review of studies in Ethiopia from 1970 to 2011 suggested that DM prevalence in the country was about 2%, rising to 5% in persons aged 40 years in certain settings. 4 A more recent nationwide World Health Organization (WHO) STEPS survey among 2153 persons in Ethiopia found the DM prevalence to be 6.5%. 5 It is therefore important to monitor and anticipate the growing burden of DM and related complications, together with treatment outcomes, for the purpose of resource planning (i.e., the human and material resources needed to diagnose, treat and manage this disease) and to inform future control and management strategies.A previous study in two specialised hospitals in Addis Ababa documented the trend in DM admissions between 2005 and 2009, noting that admissions increased from 51 per annum to 245 over this period. 6 Up-to-date information on the indications for hospital admission, the types of DM, existing complications and hospital outcomes is important, as this will help policy makers and health care staff better understand the DM burden and associated comorbidities. In Ethiopia, where there are no community-level studies on the burden of DM, hospital data serve as a useful proxy.The aim of the present study was therefore to document indications for admission, complications and hospital outcomes of patients with DM admitted to the largest referral hospital (in Addis Ababa, Ethiopia), and compare findings between patients with type 1 and type 2 DM. Specific objectives for patients stratified by type of DM were to describe 1) demographic characteristics and indications for hospital admission, 2) existing complications and comorbidities, and 3) hospital outcomes. METHODS Study designThis was a retrospective descriptive study using medical files. SettingGeneral setting Ethiopia, located in the Horn of Africa, is the third most populated country in sub-Saharan Africa, with 80 million inhabitants, of whom 80% live in rural areas. The country has arou...

SettingNational Institute of Tuberculosis and Respiratory Diseases (erstwhile Lala Ram Sarup Institute) in Delhi, India.ObjectivesTo evaluate before and after the introduction of the line Probe Assay (LPA) a) the overall time to MDR-TB diagnosis and treatment initiation; b) the step-by-step time lapse at each stage of patient management; and c) the lost to follow-up rates.MethodsA retrospective cohort analysis was done using data on MDR-TB patients diagnosed during 2009–2012 under Revised National Tuberculosis Control Programme at the institute.ResultsFollowing the introduction of the LPA in 2011, the overall median time from identification of patients suspected for MDR-TB to the initiation of treatment was reduced from 157 days (IQR 127–200) to 38 days (IQR 30–79). This reduction was attributed mainly to a lower diagnosis time at the laboratory. Lost to follow-up rates were also significantly reduced after introduction of the LPA (12% versus 39% pre-PLA).ConclusionIntroduction of the LPA was associated with a major reduction in the delay between identification of patients suspected for MDR-TB and initiation of treatment, attributed mainly to a reduction in diagnostic time in the laboratory.