Background
Currently, there is considerable pressure for country-level policy makers to decide if and how to introduce and/or scale-up the use of Xpert within existing TB control programs. In most cases, these decisions are being made without the benefit of formal projections of the probable impact and costs associated with different approaches for improved case detection. Modelled analyses can provide estimates of how much morbidity and mortality can be averted through different implementation policies, and at what cost, would provide valuable information to guide rational decision making.
Work required
TB MAC has identified an urgent need for models that are calibrated to existing epidemiological data and programmatic conditions, and that are structured to consider practical details related to diagnostic pathways and access to TB care. These features were deemed important to 1) provide guidance for the best approach for scaling up case detection within the context of existing programs; 2) determine how existing pathways to diagnosis and care can be modified to maximize case detection; and 3) understand how case detection scale-up might affect other related services (e.g. treatment of HIV and MDR-TB in some settings). In summary, new modelled analyses that can help to address these priority needs would facilitate country-level decision making by providing estimates of epidemiological and economic impact of alternative strategies for case detection scale-up, with Xpert as one of the options considered.
The proposed modelling should ideally include modelling the epidemiological features of the follow settings 1) high-TB, high-HIV settings; 2) high-TB, low-HIV settings; and 3) high-MDRTB, low-HIV settings, and preferably in countries where less current Xpert modeling has been focused. The ideal analysis will be firmly grounded in a particular set of countries, and will explore the generalizability of the findings to other epidemiological settings.
Aim
To develop models that project the epidemiological impact and costs associated with strategies for case detection scale-up within particular country settings.
Objectives:
For the proposed country settings:
- To determine which defined population groups and clinical contexts are high priority for case detection scale up and what diagnostic algorithms should be designed for these groups under a range of resource constraints
- To identify the priority aspects of TB diagnosis and treatment programs that must be strengthened to maximize case detection, and to suggest how this might be accomplished
- To assess how the implementation of case detection scale up may affect uptake, utilization, and resource needs of related health services (e.g. HIV and MDRTB services)
Deliverable(s)
1) One manuscript (5-20 pages) submitted for publication in an international peer-reviewed scientific journal by grant end date + 3 months,
2) One presentation (15-30 slides) to be:
- i) submitted to TB MAC by the grant end date, and
- ii) presented at a TB MAC or other international meeting/conference by grant end date + 6 months.
Mechanism
A contract will be issued from LSHTM either to an institution or to an applicant personally in the form of consultancy fees.
Standard terms
Work done with and for TB MAC is subject to a standard set of terms that require information sharing between all groups working within TB MAC. A full set of terms is available on request.
Eligibility
Members of the TB MAC Secretariat and Advisory Panel are not eligible for this award.
Format
Applications should include a proposal limited to three pages (excluding references, and with a minimum of 11 point font size). Proposals should include: (i) an introduction to the topic; (ii) description of previous work in the area by the applicants; (iii) description and justification of the intended approach; (iv) timeline for the proposed work; (v) budget and its justification. In addition, the principal applicant should provide a separate short bio-sketch (one page summary of qualifications, research interests, key funding publications and major sources of research support).
Assessment criteria
All proposals will be reviewed by the TB MAC Advisory Panel and by external expert reviewers. Proposals will be scored on the following criteria:
- Analyses address important questions for case detection scale up and implementation.
- Proposed modelling approach is innovative and credible.
- Results of proposed analysis would be relevant to policy makers.
- Appropriate timeline and budget.
- Preference will be given to models that address country settings in which there is relatively little existing modelling of Xpert. The intention here is to stimulate modelling to fill research gaps.
Summary details
Title: Modelling to support the scale-up of TB case detection within countries
Reference: TB MAC RFA 2.1
Duration: Up to 12 months
Funds available: Up to US$130,000
Number of awards available: 1
Submission opening date: 14th July 2013
Submission closing date: 5th August 2013
Decisions announced: 5th September 2013
Contact: Olivia Ross-Hurst Olivia.Ross-Hurst@lshtm.ac.uk
