Marshall G. Streptomycin in the treatment of pulmonary tuberculosis. Its publication comes in the wake of commitments from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to increase the uptake of operational research proposals for TB in order to maximize the impact of the Global Fund's investments. We then summarize, through a compilation of published literature and consultation with 35 researchers across multiple disciplines in the London School of Hygiene and Tropical Medicine TB Centre, priorities identified by the tuberculosis research community.
We use cookies to help provide and enhance our service and tailor content and ads. World Health Organization. On seeing the renewed calls for increased funding, some researchers have questioned whether we can justify being stewards of substantial funding for global health “if we cannot manage a disease as well known as tuberculosis” [7]. PubMed volume 14, Article number: 123 (2016) Cite this article. Geneva: Stop TB Partnership; 2015. We summarise existing priority statements and assess the rigour of the methods used to generate them. Methods used to identify these priorities were varied.
2006;367(9514):940–2. These priority research areas included improved understanding of tuberculosis transmission dynamics, the role of social protection and social determinants, and health systems and policy research.
The recommended level of R&D funding for basic science was set at $420 million per year. To put tuberculosis research funding levels into context, an analysis of research investments for UK institutions concluded that tuberculosis is underfunded in comparison to HIV and malaria, despite causing the most mortality; between 2011 and 2013, tuberculosis research received only 20 % of the total $344 million funding, whereas HIV and malaria received approximately 40 % each [17]. Wallis R, Pai M, Menzies D, Doherty T, Walzl G, Perkins M, Zumla A. Biomarkers and diagnostics for tuberculosis: progress, needs, and translation into practice. Within the individual research areas in the Global Plan, tuberculosis researchers’ priority objectives included developing better (more potent, less toxic, shorter duration of treatment) drugs for drug-resistant and drug-susceptible tuberculosis, identifying biomarkers for disease progression and immune responses, developing vaccines that are effective in adults and HIV-infected individuals, making accessible point of care diagnostics for all forms of tuberculosis and assessing strategies to optimize implementation of tuberculosis control strategies. 2015;13:63. http://tb.lshtm.ac.uk/about-us/members/. We found 33 documents that specifically outline priorities in tuberculosis research. Policymakers and funders often prefer a biomedical approach to disease control and pay less attention to addressing more complex sociopolitical realities and their impact on the causal pathways of disease [20]. © 2020 BioMed Central Ltd unless otherwise stated. Article Geneva: Stop TB Partnership; 2006.
Furthermore, we believe that a simple exercise in which national tuberculosis program representatives score the potential impact of findings from a number of recently completed studies would be very informative, and potentially surprising, for researchers and funders alike. This view is echoed in a review of numerous studies carried out by the British Medical Research Council’s tuberculosis units between 1946 and 1986, which made the striking assertion: “[by the late 1980s] all of the measures necessary for successful programmes for the control of tuberculosis had been delineated” [3]. Frick M. 2015 Report on Tuberculosis Research Funding Trends, 2005–2014: A Decade of Data. A consensus statement on MDR tuberculosis was published by the Stop TB Partnership's working group on MDR tuberculosis. Discovering Tuberculosis: A Global History 1900 to the Present. An update was provided for the 2011–2015 period in order to set out a clearer plan for reaching the Millennium Development Goals and Stop TB Partnership’s 2015 targets of halving tuberculosis prevalence and deaths compared with 1990 levels [16]. Translating theory into practice: Targeted tuberculosis control in meerkats of the Kalahari.
Respondents were asked to identify their top research priorities for tuberculosis control.
BMJ. We classified research topics into the same five research areas used in the Global Plan, or into ‘others’ if they did not fit into any of the five research areas. The greatest discrepancy between targeted and achieved funding was for new diagnostics, which received less than one-fifth of the $340 million goal for 2014. Engaging local researchers would not only build research capacity and reduce costs from engaging primarily international teams, but also potentially aid dissemination and uptake of findings into policy.
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$���Y �H�T &WHpE��K��Y������0 �� Royal Veterinary College (RVC) PhD student Stuart Patterson will shortly be commencing research which aims to improve our understanding of TB control in wild animals. 2008;197(11):1493–8. The ancient scourge, tuberculosis, was the subject of the world’s first randomized controlled trial reported in 1949 [1], and since then numerous studies have generated robust evidence about effective interventions for tuberculosis control [2]. To ensure that funding priorities, researchers’ agendas and national tuberculosis control policies are better coordinated, there should be more, and wider, dialogue between stakeholders in high tuberculosis burden countries, researchers, international policymakers and funders. Google Scholar. Although many of the priority research questions identified by researchers fell within the Global Plan categories, our analysis highlights important areas that are not explicitly mentioned in the current plan. With a target of $1.16 billion for 2014, these two areas accounted for 60 % of the recommended R&D funding. It is thus encouraging that the new Global Plan to End TB 2016–2020 recognizes that “medical interventions alone will not be enough to end tuberculosis” and stresses the importance of Universal Health Coverage and social determinants [5]. Operational research, which had the lowest target, received 66 % of its target funding, whereas new diagnostics received only 19 %. BMC Medicine The Global Plan to Stop TB 2006–2015. 2009;87(6):405–84. Finally, we combined the quantitative and qualitative data into a single table (Table 1) to compare researchers’ priority topics with the global funding agendas and activities, highlighting key gaps. Multidrug-resistant and extensively drug-resistant tuberculosis: the National Institute of Allergy and Infectious Diseases Research agenda and recommendations for priority research. Data on the amount of funding actually allocated by global funding bodies in 2014 was extracted from the 2015 Treatment Action Group report [2], classified into the same five research areas as used by the Global Plan. Finally, health systems and policy research is not yet included as an independent research area in the Global Plan. PubMed
London School of Hygiene and Tropical Medicine. Through decades of research, numerous studies have generated robust evidence about effective interventions for tuberculosis control. 1999;3:S231–79. The interviews were conducted at the annual TB Centre meeting under the supervision of a PhD student at LSHTM, and were recorded with respondents’ permission. The role of social protection and social determinants in tuberculosis is another area that researchers directed attention towards; indeed, there is a danger that neglecting to tackle socioeconomic determinants of tuberculosis may justify criticisms about failing to learn lessons from the massive reduction in tuberculosis incidence in much of Europe, which was achieved without drugs, vaccines or technologically-advanced diagnostics [19]. RC and HF contributed to writing the manuscript and all authors provided critical input. By using this website, you agree to our Finally, interviews with representatives of key funding agencies would help to better understand why some diseases are funded disproportionately relative to disease burden (or potential public health impact), why narrow technology or biomedical approaches are often prioritized and how best to influence the research funding agenda.
Khan, M.S., Fletcher, H. & Coker, R. Investments in tuberculosis research – what are the gaps?. The author’s response to reviewers is available as Additional file 1. None of the research areas were funded at the target levels in 2014 (Table 1). Through his analysis of responses to tuberculosis in the twentieth century, historian Christian McMillan highlights a pattern of ‘repetition and rediscovery’ among researchers and policymakers, owing to a tendency to ignore lessons that have been learnt [6], resulting in a squandering of resources on repeatedly addressing already answered research questions.
Fauci AS, Group NTW. Lancet. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Funding priorities are essential for the effective allocation of limited resources and they can act as a focal point for driving financial investment. Manage cookies/Do not sell my data we use in the preference centre. 1810 0 obj
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Global Tuberculosis Report 2015. While the barriers to managing tuberculosis are numerous, including its association with poverty and the generation of drug resistance owing to inadequacies in health systems, these challenges are well defined; the balance between generating new knowledge and identifying strategies to implement proven solutions is thus being questioned. 13 The research subgroup of the working group on MDR tuberculosis produced a document in which they investigated the scale-up of programmatic … The prevalence of tuberculosis (TB) can be traced back to 2400-3400 BC, and the disease still continues to remain as the global threat affecting approximately 10 million people per year.
Finally, we compare researchers’ priority areas to the global funding agendas and activities.
The top priority areas were drug development (28 articles), diagnosis and diagnostic tests (27), epidemiology (20), health services research (16), basic research (13), and vaccine development and use (13). Similarly, the Global Fund to Fight AIDS, Tuberculosis and Malaria, a funder that mainly provides programmatic support of which a small proportion goes towards research, allocated the lowest amount of funding to tuberculosis; in 2015, disbursements were $15.5 billion for HIV, $7.2 billion for malaria and $4.1 billion for tuberculosis [18].
The research proposal was subjected to screening for scientific and ethical integrity by Ethical review committee at School of Public Health, and institutional review board of the College of Health Sciences, Addis Ababa University. WHO, Stop TB Partnership, and other organisations could adopt an incremental process of priority development, building on the existing knowledge base. A Medical Research Council investigation. By continuing you agree to the use of cookies.
The Global Plan to Stop TB 2006–2015 was launched in Davos, Switzerland, at the World Economic Forum in 2006 [15].
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