Documenting the impact of health initiatives and identifying the ways policymakers enact changes that affect health programs have become extremely important areas of research within the global health community. Recognizing the need for more information on these topics, TREAT TB launched a new e-tool in February 2012 designed to introduce public health professionals and interested members of the public to the Impact Assessment Framework created by the Liverpool School of Tropical Medicine and the Policy Transfer Analysis methods developed by The Union’s Dr. Karen Bissell.  The e-tool has been tailored to fit the needs of public health professionals who fund, design, implement, or use research for policy or program implementation.  Interested individuals can access the entire program for free here.

The e-tool consists of a series of captivating slides that provide a useful framework for evaluating impact and a method for analyzing the processes involved in changing policy and practice. While the full program takes approximately one hour to complete, users may use the tabs on the side of the screen to focus on topics that are of particular interest to them. In addition to providing a thorough explanation of each concept, the e-tool also enables users to learn more by directing them to published papers on the subject.

The Health Manager, a new publication recently launched by The Union,  profiled the TREAT TB initiative as an example of a multidisciplinary partnerships working to solve global health challenges. To read the article, please click here.

With support from the US Agency for International Development, TREAT TB has published two guides for public health professionals and other researchers interested in learning more about operational research.

The first, A Guide to Country Level Implementation and Programme Support, describes effective ways public health professionals, as well as donors and non-governmental organisations, can support operational research activities at the programme level.  It also describes examples of The Union’s work in several key projects including the TREAT TB-National Tuberculosis Institute protocol development workshop,  the Centre for Operational Research’s Fellowship Programme and the PROVE IT study in Brazil.

With this guide, readers can learn essential steps to conducting operational research, including how to conduct a situational analysis,  the importance of a research agenda based on a carefully conducted priority setting exercise, the benefits of community engagement, and the types of training activities that facilitate operational research activities.  In the appendices, the guide also provides resources, such as the Impact Assessment Framework developed by the Liverpool School of Tropical Medicine and on The Union’s approach to Policy Transfer Analysis.

The second guide, Operational Research to Improve Health Services: A Guide for Proposal Development, was published in partnership with the Desmond Tutu TB Centre at Stellenbosch University in South Africa.  This guide contains the materials used during the Operational Research Assistance Project, an initiative funded by the USAID mission in South Africa that aims to build a sustainable focus on and more unified approaches to operational research as an integral component of the National TB Control Programme in South Africa.  By reading this guide, potential researchers and public health professionals can learn more about designing an effective research proposal, developing work plans and creating budgets for operational research projects.

Both guides are now available on The Union’s website  and can be found here.

TREAT TB seeks to contribute new knowledge to the global health community by conducting field evaluations of diagnostic tools, clinical trials of priority research questions, and targeted operational research benefitting global, regional and country tuberculosis (TB) control efforts.  To fulfill these goals, TREAT TB has established partnerships with several research institutions implementing important research that aims to improve the diagnosis and treatment of TB.

Some of the most important activities of the TREAT TB Initiative are being

conducted by researchers at the Northern State Medical University (NSMU) and Arkhangelsk Regional Anti-tuberculosis Dispensary (ARAD)  in Arkhangelsk, Russia.

Northern State Medical University, the Research Center of Northern Russia 

With more than 5000 students and cutting-edge facilities, NSMU is a prestigious academic institution in northwest Russia, an area encompassing all of the Arkhangelsk Region as well as the regions of Vologoda, Murmansk, Nenets, Komi Republic and Karelia. The topics of research currently being conducting at NSMU range widely, but reflect the needs of the region and of the Russian Federation. Of the university’s 55 departments, 27 are located in the city’s specialized medical clinics and provide expertise to all patients in need of medical assistance.

The PROVE IT Study in the Russian Federation

Many new diagnostic tools have become available over the last decade. Research evaluating the accuracy of these new tools has confirmed that they have the potential to greatly improve the diagnosis of TB, which currently relies on tools developed over 100 years ago.

One of these promising new tools is called the Line Probe Assay (LPA), a molecular assay designed to rapidly detect rifampicin resistance, a marker of multidrug-resistant tuberculosis (MDR-TB).  In 2008, the World Health Organization recommended LPA because this diagnostic test would enable clinicians to receive the results faster and facilitate the appropriate treatment for their patients much sooner, which would reduce the time that the patient could transmit the disease to others.

What remains unknown is how well this test will perform in real-life settings or the cost of the roll-out of this new tool on patients and health systems. NSMU has partnered with TREAT TB to obtain answers to these questions by implementing the study entitled “Policy Relevant Outcomes from Validating Evidence on the Impact of Line Probe Assay” or PROVE-IT.

Study Leadership

Professor Andrey Maryandyshev, an international expert of MDR-TB, is leading the PROVE-IT study in Arkhangelsk. Professor Maryandyshev has three decades of experience in the field and has published over 100 scientific articles related to lung health. Since 1999, he has used his expertise for the benefit of Union members and partner institutions by participating in national TB program evaluations and teaching at Union courses. Professor Maryandyshev is the principal investigator of the PROVE-IT study in Russia and will direct all study activities.

Effective Partnership

Arkhangelsk has one of the highest rates of MDR-TB in the world. In response to the urgent threat to their community’s health, medical professionals at NSMU, the Arkhangelsk Region Anti-Tuberculosis Dispensary (ARAD), the local Ministry of Public Health, and in the penitentiary sector have created a partnership that results in a system of coordinated care in which all agencies and healthcare professionals work together to provide timely diagnosis services and high-quality treatment for TB. Unlike other high-burden areas, ARAD oversees the diagnosis and treatment of all TB patients in the region.

The PROVE-IT team at the NSMU has partnered with the head of the  ARAD, Dr. Dmitry Perkhin, to conduct the technical aspects of the PROVE-IT study. ARAD physician, Dr. Platon Eliseev, will be assisting the implementation of the study by developing study procedures, monitoring study progress, and analyzing study data.

TREAT TB team will also work with leaders in both the civil sector and the penitentiary system to collect information on the actual performance and costs associated with LPA in the Arkhangelsk Region.

Impressive Progress

A delegation of senior TREAT TB partners visited Arkhangelsk to gauge the progress of the PROVE-IT study in early August 2011. The TREAT TB team was impressed with the Arkhangelsk-based researchers’ progress and looks forward to discussing the preliminary findings next year.

During the visit, Professor Donald Enarson met with the study team and discussed the technical implementation of the study as well as ways to overcome any implementation issues that may arise. The Union’s Policy Transfer Analysis expert, Dr. Karen Bissell, met with Dr. Vladimir Kuznetsov, a psychiatrist working to assess the impact of LPA on patients and stakeholders through the PROVE-IT study.

In addition to senior Union staff, experts from TREAT TB partner institutions also participated in the August 2011 visit. Medical statistician Dr. Patrick Phillips of the Medical Research Council-U.K. discussed data collection and analysis with Dr. Eliseev and other members of the study team while Dr. Gillian Mann and Russell Dacombe of the Liverpool School of Tropical Medicine went over issues related to impact assessment and laboratory procedures with the study team.