How Can Operational Research Help to Eliminate Tuberculosis in the Asia Pacific Region?

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.

Training for Tuberculosis Elimination in Indonesia: Achievements, Reflections, and Potential for Impact

“…The Structured Operational Research and Training IniTiative (SORT IT) provides an example of a training model which is inherently structured to evaluate outcomes [24,25]. This model uses on-the-job-training (a “learning by doing” methodology) [26,27,28,29], and supports participants to conduct an ethics-approved project and produce a peer-reviewed publication.…”

­­Eleven tips for operational researchers working with health programmes: our experience based on implementing differentiated tuberculosis care in south India

“…For operational researchers interested in providing technical assistance for strengthening implementation and conducting OR in health systems and programmes (TB or other health programmes), following these tips will increase the chances of i) an enriching engagement, ii) policy/practice change based on findings of OR and iii) sustained implementation after the organisation providing technical support phases out. Kumar AMV et al and Harries AD et al have discussed in detail how national TB programmes may integrate and build a culture of OR and use OR to end TB [ 5 , 24 ]. Here, we have shared our learnings in the form of eleven tips and relevant examples under each of what we did in TN-KET (see Box 3 ).…”

Learning is a means to progress and empowerment for health systems

“…32 Implementation research initiatives, for example, are reported to play a role in improving case findings, diagnosis and treatment to meet central programme targets, as part of several national tuberculosis programmes in the Asia Pacific region and are used increasingly to aid programme managers based in low-income and middle-income countries (LMICs) around the world to improve the delivery of programmes to prevent non-communicable diseases. [33][34][35][36] However, deeper forms of learning can also help health systems to embrace change better. Such changes can range from evolving societal expectations, population characteristics and disease patterns to external shifts such as the shocks caused by political and economic upheavals, natural disasters or global ecological trends.…”

“…In its simplest ‘single-loop’ form, learning enables individuals, teams and organisations to adapt and improve their regular practices to perform their stated functions more effectively 32. Implementation research initiatives, for example, are reported to play a role in improving case findings, diagnosis and treatment to meet central programme targets, as part of several national tuberculosis programmes in the Asia Pacific region and are used increasingly to aid programme managers based in low-income and middle-income countries (LMICs) around the world to improve the delivery of programmes to prevent non-communicable diseases 33–36…”