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Understanding TB control

Technologies, Ethics, Programmes

Ian Harper (Wellcome Trust Senior Invesigator Award

This 5 year Wellcome Trust Senior Investigator Award, which began in October 2012, will explore issues around the implementation of the WHO STOP TB Strategy.

Read the Wellcome Trust Press Release.

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Countries have been broadening the arenas of TB control activities to include: TB / HIV, drug-resistant forms and issues of marginalised populations; health system strengthening; empowering people and communities; and developing operational research. Four aspects of this will be researched:

1. In what ways have the Global Fund stimulated civil society and the private sector involvement? How has this changed the approach to TB control? Nepal's situation will be compared with that of Papua New Guinea.

2. What public health and ethical issues are revealed in the production and implementation of guidelines for drug resistant tuberculosis? How are these issues resolved in country? The legal and ethical implications of incarceration of patients with XDRTB in South Africa, Nepal and India will be compared.

3. Drug resistant forms of tuberculosis raise complex issues for diagnosis. New technologies have been developed (for example Gene Xpert) and are being adopted by countries around the world. What are the implications of introducing and "scaling up" these new technologies both in terms of tuberculosis outcomes, but also for broader laboratory and health systems performance? This will be conducted in India and Nepal.

4. Patient and community empowerment strategies will also be explored. Working with co-infected HIV / TB groups in Nepal, research will be developed together to look at issues of stigma and marginalisation, and how this can be addressed.

A key goal will be feedback for WHO and country policies.

Ians TB