Operational research within the national tuberculosis control programme in Benin

Abstract

ObjectiveTo document whether the placement of operational research (OR) fellows within disease control programmes in low and middle income countries leads to the implementation of operational research and improvements in policy and practice.ResultIn 2012, an OR fellow was placed within the National TB Programme, Benin, to strengthen the implementation of operational research. From 2012 to 2015, eight OR projects were implemented, of which three contributed to changes in programme practice and five provided information which was not previously available from quarterly/annual reports. Two of these projects—one on the burden and treatment outcomes of childhood TB and one on tracing patients who had discontinued treatment—are discussed in more detail. OR should be strongly encouraged within national TB programme settings and an OR fellow facilitates this process.

What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030?

“…Operational research needs to be firmly embedded within the NTP, as this enables programs to carry out local research that contributes to knowledge, tools, interventions, and strategies that can enhance the quality and coverage of service delivery and help inform better policy and practice 103 , 104 . The placement of operational research fellows within the central unit of NTPs greatly facilitates the implementation and value of this work 105 , 106 . NTPs must also form partnerships with academia to facilitate the conduct of meaningful clinical or cluster randomized trials, as demonstrated by the recent household contact assessment in Vietnam 86 .…”

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

“…Embedding operational research within the NTP is the best way to ensure that local and relevant research is implemented according to the country’s needs and priorities [66]. Malawi, Benin, Vietnam and more recently Pakistan and India are good examples of how this has worked in practice [9,10,11,12,67]. There are some key steps that need to be addressed if such an initiative is to be successful, and these are shown in Table 5.…”

“…It can be defined as research into interventions, strategies, and tools or new knowledge to enhance the quality, coverage and effectiveness of disease control programmes, health services or health systems in which the research is conducted [7]. In 2011, WHO published its “Priorities in Operational Research to improve Tuberculosis care and control” to serve as a guiding framework for NTPs [8], and there are several examples from Africa and Asia of how operational research conducted within TB control programmes can lead to improved programmatic performance with increases in case finding and successful treatment outcomes [9,10,11,12]. Specific examples of operational research that led to national policy change include: (i) HIV testing and cotrimoxazole preventive therapy in Malawi which was associated with significantly reduced country-wide mortality in HIV-infected TB patients [13]; (ii) HIV testing in patients with presumptive TB in India which led to national implementation of testing and the potential for earlier referral for antiretroviral therapy in this group of patients [14,15]; and (iii) screening of TB patients for diabetes mellitus in India which led to widespread implementation of screening for diabetes in certain regions of the country [16].…”

Organization of tuberculosis detection in Russia and worldwide

“…Индийские авторы [13,14] в углубленном исследовании пути пациента от обращения до постановки диагноза связывают проблему организации своевременного выявления туберкулеза в Индии с территориальной отдаленностью и недоступностью современных методов диагностики туберкулеза (особенно в сельской местности), отсутствием медицинской страховки у большей части населения, нехваткой квалифицированных кадров, а также с недостаточной грамотностью пациентов и, как следствие, поздним обращением к врачу. Кроме того, серьезной проблемой является недостаточная регистрация случаев туберкулеза в связи с отсутствием единого информационного поля между государственным и частным секторами здравоохранения [15].…”

“…С 2012 г. в рамках кампании «Индия без туберкулеза» в стране широко применяются экспресс-диагностика и современные препараты для пациентов с лекарственноустойчивым туберкулезом, рекомендованные ВОЗ. Кроме того, благодаря введению в 2013 г. обязательного уведомления о случаях туберкулеза и активизации работы с частным сектором за один только 2016 г. число уведомлений о новых случаях заболевания выросло на 29% [7,15]. В 2017 г. Министерство здравоохранения Индии приняло решение о создании программы активного обследования на туберкулез в труднодоступных районах среди групп высокого риска, что предусматривает ежегодное обследование на туберкулез пациентов групп риска по туберкулезу в 252 районах страны [17].…”