GLOBAL TB IMPACT MEASUREMENT - What is it? Why is it important? How can it be done? What will it cost?
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GLOBAL TB IMPACT MEASUREMENT
What is it? Why is it important?
How can it be done? What will it cost?
1. What is global TB impact measurement and why is it important?
Global TB Impact Measurement is the evaluation of whether the epidemiological
burden of TB (measured as cases and deaths) is being reduced in line with global
targets for TB control, and the extent to which changes are influenced by the
implementation of TB control interventions. It has assumed unprecedented
importance because, starting around the year 2000, there has been a fundamental shift
in the environment in which TB control is being funded, delivered and evaluated.
Between 2000 and 2004, global targets for TB control were extended to include
impact targets (reductions in cases and deaths). These impact targets built on the
"outcome targets" of detecting 70% of smear-positive TB cases and curing 85% of
detected cases in DOTS programmes that were first set by the WHO's World Health
Assembly (WHA) in 1991. The newer impact targets were set within the UN's
Millennium Development Goals (MDGs), by the Stop TB Partnership and as part of
the Stop TB Strategy launched by WHO in 2006. MDG 6 target 6.C is to halt and
reverse incidence by 2015 at global level. The Stop TB Partnership adopted this target
while also setting targets to halve global prevalence and death rates by 2015,
compared to a baseline of 1990. The Stop TB Strategy explicitly added "impact
measurement" to the regular monitoring of case-finding and treatment outcomes
previously emphasized in the DOTS strategy. The WHO's WHA recognised all of
these targets in a resolution passed in 2007 (WHA 60.19; see Annex 1). The latest
assessment of progress towards these impact targets, in WHO's 2008 report on global
TB control, was that the incidence rate was falling slowly at global level and in five of
six WHO regions (rates were approximately stable in Europe). Prevalence and death
rates were falling at around 2.5% per year worldwide, but not rapidly enough to halve
1990 rates by 2015.
Starting around 2002, financial investments in TB control have substantially increased,
and a range of initiatives and interventions have been introduced or scaled-up. Not
surprisingly, this had been accompanied by increased scrutiny of the effect and value-
for-money of these investments by the governments of TB endemic countries and
their technical and financial partners. In turn, this has generated much greater demand
for health information within a "results-based" framework; The Global Fund is a
prominent example, with its five-year impact evaluation in 20 countries and its
emphasis on performance indicators in grant agreements. To respond to this demand,
many countries need technical assistance from WHO and other technical agencies.
In combination, these factors mean that impact measurement should be a top priority
for all countries, technical agencies and financial partners committed to the
achievement of global targets for TB control.
12. The WHO Global Task Force on TB Impact Measurement
Based on WHA 60.19 (see Annex 1), WHO is required by its member states to report
on whether the 2015 global targets for TB control are achieved, to report on progress
in the interim, and to help to strengthen health information systems. The Global Task
Force on TB Impact Measurement (hereafter the Task Force) was established by
WHO in June 2006. The Task Force's mandate is to produce a robust, rigorous and
widely-endorsed assessment of whether the 2015 targets set for TB control are
achieved at global level as well as for each WHO region and individual countries, to
regularly report on progress towards these targets in the years leading up to 2015
including analysis of how progress could be accelerated, and to strengthen national
capacity in monitoring and evaluation of TB control. The Task Force includes experts
in TB epidemiology, representatives from major technical and financial agencies, and
representatives from countries with a high burden of TB.
Following two Task Force meetings (June 2006; December 2007), the Task Force has
defined and reached consensus on three major strategic pathways which will need to
be followed to fulfil the Task Force's mandate. These are:
1. Strengthening routine surveillance of TB cases and deaths including
certification and operational research. Surveillance data will be essential for
measuring TB incidence, prevalence and mortality in all countries. A
"certification" process designed to allow standardized assessment and
benchmarking of the quality of a country's TB surveillance data will be
developed and applied.1 It will include standardized analysis of routine
notification and (where they exist) vital registration data, production or use of
evidence from operational research, and either granting of "certified" status or
identification of how surveillance systems need to be strengthened. This area
of work will become increasingly important over time.
2. Implementation of disease prevalence surveys. The Task Force has
identified 21 countries in which surveys of the prevalence of disease are
necessary, mainly in Asia and Africa. Given the current limitations of routine
TB surveillance data and the long-term efforts that will be needed to
strengthen them, this area of work is critical for measuring progress towards
the 2015 targets.
3. Production of epidemiological estimates and evaluation of how trends are
influenced by TB control. Measuring progress towards the 2015 targets
requires the production of estimates of incidence, prevalence and mortality
between 1990 and 2015. Periodic review and updating where appropriate of
the data, assumptions and analytical methods that WHO uses to produce these
estimates is essential to maintain consensus around widely-used figures. This
area of work will be given particular attention in 2008 and 2009. In addition to
producing estimates, it is also important to analyse the extent to which changes
in incidence, prevalence and mortality are influenced by TB control and the
extent to which they are driven by other factors.
Each of these three areas of work is based on a Task Force review of the methods
available to measure the epidemiological burden of TB and the impact of control
efforts, which was published in Lancet Infectious Diseases in January 2008.2
1
See section 3.1 for a definition of "certification" and what would be required for "certified status".
3
Dye C et al. Measuring tuberculosis burden, trends, and the impact of control programmes. Lancet
Infectious Disease 2008 Jan 15.
23. Strategic Pathways
3.1 Strengthening routine surveillance of TB cases and deaths including
certification and operational research
The ultimate goal for all countries is to use routine surveillance data (of TB cases and
deaths) to measure TB incidence, TB prevalence and TB mortality. As countries
strengthen their routine surveillance systems, estimates of TB incidence, prevalence
and mortality will become progressively more dependent on notification of TB cases
and registration of deaths from TB, and less reliant on more imperfect data,
assumptions and complex analytical methods (see section 3.3).
The Task Force will develop and apply a "certification process" that can be used to
assess the extent to which a country's TB surveillance data are a close proxy for TB
incidence and TB deaths (i.e. they can be considered to provide a direct measure of
TB incidence and TB deaths). The certification process will consist of a standard
approach to assessment of the quality and coverage of TB surveillance data. This
approach will be relevant to all countries, with results used in one of two ways. If a
country's TB surveillance data are shown to be a close proxy for TB incidence and
deaths, then they will be given "certified" status. If a country's surveillance data are
found to record only a fraction of cases and deaths, then this fraction will be estimated.
In addition, the measures needed to strengthen surveillance to meet the standards
required for certification will be identified. All countries should aim to reach the
standards required for certified status.
Building on lessons learned from studies that have already been undertaken (e.g.
Morocco, India) as well as experience within strong TB surveillance systems (e.g. the
Netherlands, Italy), the Task Force will develop the certification process in
collaboration with national and local counterparts and with the assistance of other
experts where necessary. It will include:
• definition of a set of standard questions, tests and related data requirements
and analyses that will allow standardized evaluation of the quality and
coverage of TB surveillance data i.e. the extent to which TB surveillance data
are comprehensive and of high-quality;
• development of a standardized tool in which the standard questions and
related data requirements, analyses and tests are set out;
• definition of a set of standard benchmarks to be used to determine whether or
not a country's TB surveillance data can be "certified" or not.
Standard assessments of the quality and coverage of TB surveillance data will
logically start with an evaluation of the data produced by TB-specific information
systems (where these exist). Examples include the completeness of routine
notification reports, the consistency of notification data over time, the extent to which
data are consistent with the norms of TB epidemiology (e.g. proportion of cases with
pulmonary TB; the proportion of pulmonary TB cases that are smear-positive; and the
male/female ratio). They will then be extended to assessments that go beyond TB-
specific information systems as well as beyond the health system itself. Examples
include evidence about the number of cases that go undiagnosed in laboratories,
evidence about the number of cases being treated but not notified in the private sector
and/or public sector facilities not linked to the national TB control programme,
evidence about the number of cases without access to health facilities, and the extent
3to which TB deaths recorded in vital registration systems are also recorded in TB
notification data. Some of this evidence will come from routine data generated by
general health information systems; others will need to come from existing or new
operational research studies.
All countries will be encouraged to use the standard methods once available, and will
be supported to do so via mechanisms such as workshops and country missions.3 This
process will not only allow for evaluation of TB surveillance data, but will also be
used to help strengthen national and local capacity in monitoring and evaluation (e.g.
capacity in operational research, data management, data analysis and writing of
reports and papers). The results should also help to identify ways to accelerate
progress in TB control. For example, assessment of how many cases are being missed
by routine surveillance will show where efforts are needed to find missing cases, and
in turn to increase case detection rates.
Countries that meet the standards required for certification will be granted "certified
status". Assessed countries that do not meet the standards required for certification
will have the opportunity to discuss what needs to be done to strengthen their
surveillance systems so that they can qualify for certified status in future, and will be
supported to implement these measures wherever possible. Methods will be peer-
reviewed and published, and may have wider applicability - for example, to other
communicable diseases.
3.2 Implementation of disease prevalence surveys
While the Task Force has agreed that the ultimate goal for all countries is to be able to
measure progress in TB control using routine surveillance data, it has also recognized
that in the interim special population surveys of the prevalence of disease will be
needed. This is particularly the case for countries in the African, South-East Asia and
Western Pacific regions. These surveys are required to produce better estimates of the
number of prevalent cases of TB in countries where routine surveillance data cannot
be relied upon. New data from prevalence surveys may also help to refine estimates of
incidence and death rates (see also section 3.3).
The December 2007 meeting of the Task Force focused on where prevalence of
disease surveys need to be undertaken to measure global and regional progress
towards the 2015 targets, as well as the methods to be applied in implementing such
surveys. Based on an agreed set of epidemiological and other criteria,4 21 countries
were identified as top priorities for the implementation of prevalence of disease
surveys (these are listed in Annex 2; it is worth noting that nine out of these 21
countries are part of the five-year health impact evaluation of the Global Fund). A
further 36 countries met the basic criteria for conducting a prevalence survey, but do
not need to conduct surveys for the purposes of assessment of the burden of TB or the
impact of control at global and regional level.5 Since assessment of the impact of TB
3
A prototype tool and accompanying set of data requirements, standard analyses and tests will be used
in a workshop with 15 Latin American countries during a WHO-hosted workshop in Costa Rica in July
2008.
4
See background paper for Task Force meeting, and the meeting report.
5
For example, the African countries that met the criteria accounted for more than 90% of the region's
cases; from a global and regional perspective it is not necessary to achieve such high regional coverage
of expensive and logistically challenging surveys.
4control requires that the measurement of TB cases is carried out on (at least) two
separate occasions, some of the 21 priority countries that do not have any survey data
later than 1990 will need to conduct two prevalence of disease surveys before 2015.
The WHO guidelines for disease prevalence surveys were universally endorsed by the
Task Force.
The 21 top priority countries will be given particular attention and support by the
Task Force. For example, the Task Force's technical partners will provide training for
survey principal and co-investigators, and will ensure that each country is matched to
one or more technical partners so that the necessary level of technical assistance is
provided (Annex 3 shows existing technical support available to countries). Two
workshops for survey protocol development for countries without recent experience
of implementing surveys will be organized in 2008. Subsequently, the Task Force will
organize the provision of technical assistance including capacity-building workshops
via missions to countries. Recent experience from Asia shows that around 9 separate
country missions of around 10 days by two technical experts are needed per survey
(from protocol development through to a final workshop to discuss and finalize
results). Some of these missions may be provided by researchers from countries that
have recently implemented a disease prevalence survey, and in this way they would
contribute to strengthening the collaboration between countries with a high burden of
TB (South-South research collaboration).
Since implementation of a prevalence survey is a major organizational and logistical
undertaking, the Task Force will proactively explore the possibility of countries using
available funding (for example from Global Fund grants) to contract out survey
implementation to organizations with a long tradition of successfully implementing
large surveys. This would make survey implementation easier from a country
perspective (e.g. NTP staff would not risk being diverted from their existing
responsibilities, would not take on work in which they have no or limited prior
experience, and would not have to take on an additional workload) and would allow
technical agencies with expertise in TB control to focus on technical assistance rather
than survey implementation per se. Nonetheless, while the strictly logistical aspects of
survey implementation may be better dealt with by an external research or survey
organization, the design and implementation of these surveys will provide an
excellent opportunity for the NTP and other national and local counterparts to build
and update their capacity in areas such as TB diagnosis, study design, and data
management and analysis, and may catalyse or contribute to the strengthening of their
TB laboratory network.
In general, the Task Force will advise countries to seek financial support from the
Global Fund to cover the in-country costs of surveys (about US$ 1 million to US$ 2
million per survey). However, mobilization of funding from other donors and/or the
use of domestic sources is also encouraged. Separate funding is needed for technical
assistance (see budget in section 6. below).
The results from prevalence surveys will not only enable evaluation of progress in TB
control; they will also help to identify ways to accelerate progress in TB control. For
example, results will include the number of cases that had not had contact with health
services, the number that had not been diagnosed despite visiting health services, and
the number of cases that had not been notified due to care-seeking among providers
5not linked to the NTP. This will show where greater efforts are needed to find,
diagnose or report cases, which in turn will help to increase case detection rates.
3.3 Production of epidemiological estimates and evaluation of how trends are
influenced by TB control
WHO began to produce estimates of TB incidence, prevalence and mortality for every
country in the world in 1997. These estimates were based on case notification data,
surveys of the prevalence of TB infection and/or disease and expert assessments of the
fraction of cases being notified, as well as estimates/assumptions for key parameters
such as the fraction of cases that are HIV-positive, the fraction of cases that are
smear-positive, and the duration of disease among different types of case based on a
review of the available evidence. The original estimates, for 1997, were published in
JAMA.6 Subsequently, estimates have been published in the annual series of WHO
reports on global TB control. The current series of estimates runs from 1990 to 2006.
The existing estimates are based on data, assumptions and analytical methods that
have known limitations, and periodic review is needed to produce the best possible
estimates and to maintain a consensus around published and widely-used figures. The
Task Force will conduct a thorough review of the current methods in 2008 and 2009.
This will include consideration of the data that are currently used, whether any newer
or better data exist and could be used, current assumptions and the evidence on which
they are based, and the analytical methods that are being applied. The review will be
expected to identify:
• which data, assumptions and analytical methods should be maintained;
• which data, assumptions and analytical methods should be modified and how
this should be done;
• what new data are needed to improve the existing estimates and how these
could be generated.
When making recommendations for modifications to existing methods and related
estimates, The Task Force will keep in mind the following issues:
• the practicalities (feasibility) of producing estimates for 212 countries and
territories each year;
• the time taken to produce better data; and
• the need to ensure that any changes in estimates can be clearly explained and
justified to countries and agencies (e.g. changes are based on much better data
or a much better method).
A plan of work for the one year leading up to the production of the mortality estimates
needed for the Global Burden of Disease (GBD) project, as well as the three years to
2010 and the period up to 2015, will be produced by September 2008. A full proposal
describing this area of work, produced jointly by KNCV and WHO, is already
available for 2008 and 2009.
Apart from producing widely-endorsed estimates of incidence, prevalence and
mortality for 2015 and the years leading up to this target year, the Task Force will also
evaluate the extent to which changes in these indicators over time can be explained by
6
Dye C et al. Global burden of tuberculosis: estimated incidence, prevalence and mortality by country.
Journal of the American Medical Association, 1999, 282:677–686.
6changes in TB control. This analytical work will make use of the routine data on
implementation and financing of TB control that is collected annually by WHO, as
well as data on other indicators that might explain changes in the burden of TB (e.g.
HIV prevalence, health expenditure per capita, income per capita, migration,
urbanization, risk factors such as use of tobacco). A recent example of such work is an
ecological analysis of the determinants of TB.7
4. Organization of Task Force work
The Task Force is hosted, convened, and managed by WHO HQ, Geneva. Three
groups (sub Task Forces) have been established to cover each of the three areas of
work defined above, with membership based on the interest and expertise of Task
Force members. In some cases, Task Force members have nominated other experts
from their respective agencies to participate in one or more of the three areas of work.
Other experts will also be invited to participate in Task Force work on an ad-hoc basis,
as appropriate.
Each of the three groups has been assigned a leader/coordinator, who is ultimately
responsible for ensuring that the each group fulfils the mandate that the Task Force
has assigned to it (there are two co-leaders in the case of Area 3). One full-time
epidemiologist at WHO serves as the secretariat to the Task Force as a whole, as well
as contributing to the work of each sub Task Force. Each group will be requested to
regularly report back to the full Task Force (at least once but sometimes twice per
year). International and national technical partners will be mapped to support in-
country work related to prevalence surveys, assessment of surveillance systems, and
analytical methods. Dr Jaap Broekmans, former Executive Director of KNCV
Tuberculosis Foundation in the Netherlands and former Chair of the WHO Strategic
and Technical Advisory Group on TB (STAG-TB), is the Chair of the Task Force.
5. Task Force Membership
TB Endemic countries: Representatives from countries with a high burden of TB.
Task Force meetings to date have included representatives from India, Indonesia,
Malawi, Nigeria, the Philippines, South Africa, and Tanzania.
International technical agencies with expertise in TB epidemiology: CDC
(Centers for Disease Control, Atlanta, USA); ECDC (European Centre for Disease
Control, Stockholm, Sweden); KNCV Tuberculosis Foundation (The Hague, the
Netherlands); RIT (Research Institute for Tuberculosis, Tokyo, Japan); the Union
(International Union against TB and Lung Disease, Paris, France); WHO (HQ and
Regional Offices).
Financial agencies: The Global Fund; USAID (United States Agency for
International Development); the World Bank.
For the Task Force to successfully implement its mandate, all partner institutions must
be fully committed. These include the Global Fund, the World Bank, bilateral donors,
national and international technical agencies, and of course the countries themselves.
There is already strong evidence of country commitment to implementing disease
7
Dye C et al. Determinants of trends in tuberculosis incidence: an ecologic analysis for 134 countries.
Unpublished paper available from the authors.
7prevalence surveys, and both the World Bank and the Global Fund strongly endorsed
the Task Force's work at the December 2007 Task Force meeting.
6. Budget
The budget for the three years 2008–2010 is presented in Table 1.
Table 1: Budget for Impact Measurement, 2008–2010, US$
1) Global coordination and strategy, and technical support 2008 2009 2010 Total
Meetings of full Task Force (1 in 2008, 2 in 2009, 1 in 2010, @ 60,000 120,000 60,000 240,000
US$60,000 each)
Meetings of three sub Task Forces (surveillance, prevalence 105,000 210,000 210,000 525,000
surveys, analytical methods; 1 meeting each in 2008, 2 meetings per
sub Task Force in each of 2009 and 2010, @US$35,000 each)*
Secretariat for 3 groups at WHO-HQ (1 full time epidemiologist, 2 510,000 510,000 510,000 1,530,000
senior epidemiologists for 50% of their time, 1 epidemiologist for
50% of their time)
Senior adviser and Task Force Chair, including travel 82,700 82,700 82,700 248,100
Miscellaneous costs (e.g. conference calls, administrative support) 30,000 30,000 30,000 90,000
Subtotal, global coordination and strategy 787,700 952,700 892,700 2,633,100
2) Strengthening routine surveillance
Development of tool(s) for standardized assessment/evaluation of a 200,000 200,000 400,000
country's surveillance system (including certification process)**
Regional workshops (4 external facilitators + 25 participants) 150,000 300,000 300,000 750,000
Country missions (2 experts, 5 days per mission, 10 countries visited 130,000 130,000 130,000 390,000
per year)
Consultant fees for external experts (10 days per mission, US$700 70,000 70,000 70,000 210,000
per day)***
Subtotal, strengthening routine surveillance 550,000 700,000 500,000 1,750,000
3) Special population surveys of the prevalence of disease
Training workshops for protocol development for 9 African 150,000 150,000
countries and Pakistan (4 external facilitators + 15 participants per
workshop)
Survey data analysis capacity building workshop (Asian countries) 150,000 150,000
Country visits to provide technical assistance to the 21 priority 416,000 832,000 1,264,000 2,512,000
countries the Task Force recommends should implement surveys,
excluding consultant fees (9 per country-survey***, 2 experts, 10
days, @US$16,000 per visit of 2 experts and US$144,000 per
survey)
Consultant fees for country visits (US$14,000 per 10-day visit of 2 364,000 728,000 1,106,000 2,198,000
consultants)****
Subtotal, special population surveys of the prevalence of disease 1,080,000 1,560,000 2,370,000 5,010,000
4) Analytical methods used to produce epidemiological estimates
Country visits (2 people per visit for 5 days) 52,000 104,000 104,000 260,000
External consultants (statistics, mathematical modeling, 115,000 115,000 115,000 345,000
epidemiology)
Subtotal, analytical methods used to produce epidemiological 167,000 219,000 219,000 605,000
estimates
5) Contingency budget***** 258,470 258,470
Total 2,843,170 3,431,700 3,981,700 10,256,570
* based on recent budget required for meeting of 10 members of a sub Task Force
** based on recent budget required for development of a new tool (WHO planning and budgeting tool)
***based on recent evidence about the amount of technical assistance that is required, from Asian
countries
****based on consultant fee daily fee rate paid through USAID's TB Control Assistance Program
(TBCAP), which is used by all the major technical partners involved in TB control
***** contingency budget to prepare in advance for the possibility of unexpected bottlenecks. If this
budget is not spent in 2008, it will remain for 2009 and 2010.
8It is estimated that US$ 10.3 million is needed over 3 years, with US$ 5 million for
prevalence of disease surveys, US$ 1.8 million for strengthening routine surveillance,
US$ 0.6 million for analytical methods and US$ 2.6 million for global coordination,
strategy and technical support covering all three areas of work. The in-country costs
of implementing prevalence surveys per se have not been included in this total, but as
noted above are expected to cost around US$ 42 million. Similarly, the in-country
costs of operational research related to the assessment of routine surveillance data
have not been included.
While the global coordination budget will need to be provided mainly to WHO, funds
for the other items in the budget will be shared among Task Force technical partners
according to their contribution to the different areas of work. For example, funding for
the technical assistance needed for disease prevalence surveys will be linked to the
number of countries that each agency commits itself to supporting (see Annex 3 for a
current mapping of technical agencies to countries).
7. Dissemination of policies, recommendations and findings and their
expected impact
Several high-profile and in-demand products will be produced to communicate the
policies and recommendations of the Task Force, and to disseminate findings from the
assessments of routine surveillance data, prevalence surveys and analytical work
described in section 3. These products will be a mixture of official WHO publications,
reports, and papers for publication in peer-reviewed journals.
Global-level products
1. Report and peer-reviewed paper with a final set of estimates of incidence,
prevalence and deaths in 2015 and assessment of whether or not the 2015
targets were met globally, for the six WHO regions and in individual countries.
2. Annual updates on progress towards the 2015 targets in the annual series of
WHO reports on Global Tuberculosis Control (2009 report onwards).
3. Methodological papers related to certification of surveillance systems.
4. WHO Policy paper on Impact Measurement (2008).
5. Estimates of global mortality due to TB for the Global Burden of Disease
project (to be published in 2010).
6. Analyses of the extent to which TB control or other factors explain changes in
the epidemiological burden of TB.
Country-level products
1. Reports and papers on the epidemiological burden of TB and the impact of
TB control efforts for selected countries, based on analysis of routine
surveillance data (and related operational research).
2. Reports and papers on the epidemiological burden of TB and the impact of
TB control efforts for selected countries, based on prevalence surveys.
3. Analyses of the extent to which TB control or other factors explain
changes in the epidemiological burden of TB.
These products will help countries, regions and the world as a whole to monitor
progress in TB control using the best possible methods; to use data to show how
progress in TB control can be accelerated, and to strengthen capacity in monitoring
and evaluation in the process.
9Annex 1
Extracts from World Health Assembly Resolution WHA60.19, passed in 2007
The WHA urges all Member States:
"… (b) accelerating improvement of health-information systems, both in general and
for tuberculosis in particular, in order to serve the assessment of national programme
performance;"
1. The WHA requests the Director-General:
"… (5) to strengthen mechanisms to review and monitor estimates of impact of
control activities on the tuberculosis burden, including incidence, prevalence
and mortality with specific attention to vulnerable groups highly at risk, such
as poor people, migrants and ethnic minorities; …
…(8) to report to the Sixty-third World Health Assembly through the Executive
Board on :
… (b) progress made in achieving the international targets for tuberculosis
control by 2015, using the "proportion of tuberculosis cases detected and
cured under DOTS" (Millennium Development Goal indicator 24) as a
measure of the performance of national programmes, and tuberculosis
incidence and "prevalence and death rates associated with tuberculosis"
(Millennium Development Goal indicator 23) as a measure of the impact of
control on the tuberculosis epidemic."
10Annex 2
Priority list of countries for carrying out TB disease prevalence surveys, as
agreed by the December 2007 Task Force on TB Impact Measurement.
Availability
5 year of funding for
Estimated
High evaluation surveys to be
Region Country TB SS+*
burden Global conducted in
prevalence
Fund** the next 3
years
AFR high HIV Kenya yes 154.2 No No
Partial,
AFR high HIV Malawi no 239.1 Yes
Global Fund
AFR high HIV Mozambique yes 244.7 Yes No
Partial,
AFR high HIV Nigeria yes 226.3 No
Global Fund
Yes,
AFR high HIV South Africa yes 395.8 Yes
domestic
Partial,
AFR high HIV Uganda yes 237.2 No
Global Fund
Yes,
AFR high HIV UR Tanzania yes 204.7 Yes
Global Fund
AFR high HIV Zambia no 291.4 Yes ?
AFR low HIV Ghana no 158.3 Yes No
AFR low HIV Mali no 243.1 No No
AFR low HIV Rwanda no 278.1 Yes No
AFR low HIV Sierra Leone no 416.0 No No
No - but
proactively
EMR Pakistan yes 132.5 No
looking for
funding
SEA Bangladesh yes 142.1 No N.A.
SEA Indonesia yes 106.6 No N.A.
SEA Myanmar yes 75.6 No N.A.
No - applying
SEA Thailand yes 84.4 No in Global Fund
Round 8
WPR Cambodia yes 267.3 Yes N.A.
WPR China yes 89.4 No N.A.
WPR Philippines yes 165.9 No N.A.
WPR Viet Nam yes 89.5 Yes N.A.
* per 100,000 individuals
** Five-Year Evaluation of the Global Fund - Study area 3: Health Impact.
N.A. Not applicable i.e. survey not due in the next 3 years.
11Annex 3
Ongoing or recently completed national prevalence surveys and supporting
technical agencies
Bangladesh ICDDR B(International Center for Diarrhoea Disease Research,
Bangladesh) , KNCV, (WHO)
Myanmar RIT/JATA WHO and JICA
(sub
national )
Philippines TDF (Tropical Disease Foundation), KIT (Korean Institute for TB),
(US- CDC, RIT/JATA, WHO)
Indonesia, WHO
Vietnam KNCV Tuberculosis Foundation, WHO, RIT/JATA,
Upcoming national prevalence surveys that have already identified potential
candidates supporting technical agencies (as of April 2008)
KNCV Tuberculosis Foundation
Kenya
KEMRI (Kenya Medical Research Institute)
Liverpool School of Tropical Medicine
National College of Medicine
Malawi
REACH (Research on Equity and Community Health - Malawi)
US-CDC
Mali KNCV Tuberculosis Foundation
Nigeria US-CDC
Damien Foundation
Rwanda INS (Institut National des statistiques)
Université Nationale du Rwanda - École de Sante Publique
NIMR (National Institute for Medical Research)
MUCHS (Muhimbily University College of Health Sciences)
Tanzania
KNCV Tuberculosis Foundation
Institute of Tropical Medicine, Antwerp, Belgium
Uganda Kampala University
Zambia ZAMBART (Zambia AIDS Related TB Research Team), RIT/JATA
Cambodia RIT/JATA, WHO
Myanmar WHO, RIT/JATA JICA , and PSI (Population Service Institute)
Thailand RIT/JATA
Pakistan WHO, the Union , KNCV
Other countries on the priority list
Ghana, South Africa, Mozambique, Sierra Leone, and China
12Annex 4: Members of each sub Task Force
Area 1 (Routine surveillance data)
Ana Bierrenbach (leader/coordinator, WHO-HQ), Chen-Yuan Chiang (the Union),
Peter Gondrie (KNCV), Nico Kalisvaart (KNCV), Mehran Hosseini (WHO-HQ),
Eugene McCray (CDC), Andrei Dadu (WHO/EURO), Lindiwe Mvusi (NTP, South
Africa), Ryuichi Komatsu (Global Fund), Amal Bassili (WHO/EMRO), Davide
Manissero (ECDC), Ibrahim Abubakar (Health Protection Agency, UK).
Area 2 (Prevalence surveys)
Ikushi Onozaki (leader/coordinator, WHO-HQ), Ana Bierrenbach (WHO-HQ),
Philips Patrobás (WHO, Nigeria), Eliud Wandwalo (NTP, Tanzania), PG Gopi
(Tuberculosis Research Centre, Chennai, India), Norio Yamada (RIT/Japan anti-TB
Association), Eugene McCray (CDC), Daniel Chemtob (NTP, Israel), VK Chadha
(National Tuberculosis Institute, Bangalore, India), Amal Bassili (WHO/EMRO).
Area 3 (Production of epidemiological estimates and evaluation of trends)
Marieke van der Werf (co-leader/coordinator, KNCV), Brian Williams (co-
leader/coordinator, WHO-HQ), Ikushi Onozaki (WHO-HQ), Catherine Watt (WHO-
HQ), Eliud Wandwalo (NTP, Tanzania), Philippe Glaziou (WHO-WPRO), PG Gopi
(Tuberculosis Research Centre, Chennai, India), VK Chadha (National Tuberculosis
Institute, Bangalore, India), Norio Yamada (RIT/Japan anti-TB Association), Davide
Manissero (ECDC, Stockholm), Daniel Chemtob (NTP, Israel), Andrei Dadu
(WHO/EURO), Amal Bassili (WHO/EMRO).
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