McGill International TB Centre supports innovative initiatives in high-burden regions

November 28, 2017

Group is providing technical support in research and knowledge translation to grassroots projects

Innovators in Health team with Amrita Daftary and Sophie Huddart from the McGill International TB Centre in Bihar, India. Innovators in Health’s community-based, active-case-finding approach has more than doubled case notification rates in a pilot population. In Wave 5, they are now scaling their intervention to cover 1 million rural residents. The intervention involves training local community health workers (ASHA workers) to screen patients at their doorstep and assist them in navigating the health care system.

Home visit of Dr Ly Chansophal, Project Coordinator in Cambodia to provide counseling and drug treatment literacy at patient’s house for the patient and families members. An initiative led by the KHANA group in Cambodia is leading a trial of three community-based innovations for improved early detection and linkage to treatment in four provinces. The group is mobilising community-based counsellors to support individuals suspected to have TB, is involving local government commune councils, and driving for increased early case detection and more effective linkage to treatment. They have detected more than 75 TB cases since the beginning of August. They are undertaking qualitative research to assess the acceptability and feasibility of their intervention. “Operational Research will help to inform the program development and also the program performance to achieve the established goals and objectives responding to the needs and demands of clients,” says -Mr. Choub Sok Chamreun, Excecutive Director and Chief of Party of the HIV/AIDS Flagship Project, KHANA.

Based on its academic reputation and important contributions to tuberculosis (TB) research and scholarship through the McGill International TB Centre (MITBC), McGill University was a natural candidate to provide technical assistance to grassroots groups around the globe working in areas highly impacted by TB. The result was a grant being awarded in September 2016 to a team led by Dr. Madhukar Pai, Professor and Canada Research Chair in the Department of Epidemiology, Biostatistics and Occupational Health (EBOH), Director of McGill Global Health Programs and Co-Associate Director of the MITBC to provide support to groups receiving funding through the TB REACH initiative.

TB REACH, administered by Stop TB Partnership, to which the Canadian government contributes substantially, provides funding for initiatives to test innovative approaches and technologies aimed at increasing the number of people diagnosed and treated for TB and decreasing the time it takes for appropriate treatment to ultimately improve treatment success rates. The program focuses on reaching people with limited or no access to TB services.

While the first cycle of TB REACH funding saw many successes in terms of project outcomes there was minimal dissemination of results. Few grantees shared their findings through formal publications and most outputs were driven by Stop TB Partnership and their consultants. As a result, knowledge management and translation were seen as vital components for the second round of funding.

SHDEPHA+KAHAMA team with Danielle Cazabon from the McGill International TB Centre in Kahama, Tanzania. The MITBC group is working in close collaboration with grantees at SHDEPHA+KAHAMA in Tanzania to guide data collection for their intervention and operational research protocols. “Many individuals in Tanzania’s rural areas, such as Kahama, have experienced serious cough with no understanding that it is as a result of TB. Most of them have been using cough syrup or other local related herbs, until when the Peer Educators and Community Health Workers were trained by SHDEPHA + KAHAMA under the financial support from TB REACH WAVE 5 which visited them and created awareness of the TB epidemic. After the awareness efforts, individuals who perceived TB as a coughing disease (Asthma) in the community agreed to go for screening and testing services and thus some were found TB negative and others positive. We appreciate the work, well done by the Peer Educators and Community Health Workers,” says Program Director Venance Zacharia.

Engaging a patent medicine vendor in his shop in Nigeria. The German Leprosy and TB Relief Association is leading a project that seeks to improve the perennially low TB case notification in six hard-to-reach riverine Local Government Areas in the Niger Delta with a population of about 1.6 million, using a community-driven output-based-approach. As of August the team has identified 962 presumptive TB cases, with 72 TB cases having been diagnosed and 66 cases having started treatment. “Reaching the underserved, particularly women and children, with TB services in the Niger Delta is no longer an obligation but has become a moral imperative. For too long the Nigerian TB programme has been content with increasing case finding. However, to be effective, a communicable disease control programme must also be interested in drastically reducing diagnostic and treatment delay. Operational research has a huge role to unearth the magnitude of the problem and unearth ways that the problem can be solved within the prevailing local context,” says Medical Coordinator Dr. Joseph N. Chukwu.

Supporting initiatives across the globe

The McGill involvement kicked-off in May with a series of capacity-building workshops hosted in Bangkok. Grantees were offered to have fees waived to attend the McGill Summer Institute in Infectious Diseases and Global Health and the MITBC group has been sharing news and resources with the grantees on a quarterly basis.

The MITBC team is supporting 20 of the 38 current TB REACH-funded initiatives, though they have been working more hands-on with six of the groups according to Danielle Cazabon, a Project Manager at the MITBC who has been helping to lead this initiative. “We are providing support in a number of different ways, including assistance for operational research (OR), technical assistance for both the primary project and OR components and knowledge dissemination support,” explains Danielle. “A number of the grantees are conducting operational research in addition to their primary project and we are helping them in developing, designing and operationalizing their research questions.”

The McGill group is providing assistance with data management, health economics and qualitative research, is reviewing drafted manuscripts and helping to develop dissemination outputs, such as policy briefs. For the grantees, including an operational research component adds value to their results. “For too long the Nigerian TB programme has been content with increasing case finding,” says Dr. Joseph N. Chukwu, Medical Coordinator for an initiative being led by The German Leprosy and TB Relief Association in the Niger Delta.   However, to be effective, a communicable disease control programme must also be interested in drastically reducing diagnostic and treatment delay. Operational research has a huge role to unearth the magnitude of the problem and unearth ways that the problem can be solved within the prevailing local context.”  Danielle notes that having an operational research component to these initiatives can also help to inform future policy and programmes.“These questions can be very pertinent to health care systems that are likely divvying up money and resources to many programs. Dissemination plays a key role in the sustainability of a successful intervention and in allowing other implementers around the world to learn from these interventions, whether they are successful or not. Most importantly, the operational research and dissemination of results can help build a case for scaling up the successful interventions so that more people suffering from TB can be identified and cured.”

November 28, 2017