Along side Challenge TB's country projects there were six global projects. These projects mainly focussed on research and were multi country/multi year in nature.
Six Challenge TB Global Projects
1. Bedaquiline Introduction
3. UN Special Envoy for Tuberculosis
4. Catastrophic Costs
6. Global Fund Hub
The Bedaquiline (BDQ) core coordination project supported the introduction of BDQ in Challenge TB countries.
The generic BDQ implementation plan for countries identified five steps, which were also applicable to the introduction of Delamanid and other new drugs:
Challenge TB supported the rapid introduction of new drugs and regimens using a two pronged approach. Firstly by supporting a clinical center of excellence to start treating eligible patients with regimens that contain the new drugs in combination with adequate companion drugs. Secondly, in collaboration with local partners Challenge TB supported regulatory processes, systems and capacity building in preparation of programmatic use of the new drugs. A user-friendly implementation planning tool and a generic programmatic and clinical guide based upon the KNCV-developed ‘Patient Triage Concept’ has been developed and adapted in several countries (Indonesia, Kyrgyzstan, Nigeria, Tajikistan, Ukraine and Vietnam), while adaptation is on-going in several other countries (Botswana, DRC, Mozambique and Uzbekistan).
The Stigma Project aimed to develop valid, feasible and efficient methods to measure TB stigma within the community, patient and health worker populations. In May 2016, two meetings on TB Stigma were held in The Hague which galvanized academic, policy and practitioner support for improved measurement and intervention on TB stigma. In addition, six new studies on TB stigma measurement methods were completed and presented internationally. Collectively, these studies represent a significant advance in the TB measurement field - answering some basic questions that set the stage for correct measurement tools and methods in future.
UN Special Envoy for Tuberculosis
The goal of the UN Special Envoy (UNSE) for Tuberculosis, Dr. Eric Goosby, was to promote and garner high level support for the dissemination and implementation of the global End TB Strategy and its targets for TB prevention, care and control. The strategy has largely been successful and the advocacy work done by the UNSE-TB has contributed to successful Global Fund replenishment ($12.9 billion) as well as PEPFAR policy change, reinforcing the need for TB prophylaxis, testing and IPT reporting for persons living with HIV.
One of the targets of the End TB Strategy is that no TB patient nor their household should face catastrophic costs due to TB, and this target should be achieved by 2020. To monitor progress towards this target, countries will need to measure the occurrence of catastrophic costs as part of the package of investigations required to better describe local and national TB epidemiology, health seeking, and health and social care systems bottlenecks.
This project field tested a generic protocol and instrument for national TB patient costs surveys to identify patient and health system predictors and the reasons for catastrophic costs in order to guide policies on cost mitigation. In addition, the project aims to determine the baseline and periodically measure the percentage of TB patients treated in the NTP network (and their households) in the country who incur catastrophic (direct and indirect) costs.
In the second year of CTB, field testing of a generic protocol and data collection tool for national TB patient costs surveys took place in Vietnam. Starting in May 2016, the NTP and CTB began implementing a nationally representative patient cost survey involving 720 eligible TB patients – including 57 MDR-TB patients - in health facilities across 20 clusters. The survey, which will be finalized by December 2016, will produce a baseline measure for the percentage of TB-affected households experiencing catastrophic costs due to TB in Vietnam. The implementation of this survey is highly relevant for Vietnam which has expanded its social health insurance system with the aim of achieving universal health coverage by 2020. The experience from Vietnam will provide inputs to draft a final tool that can be used in other countries.
This project was a randomized, pragmatic, open-label trial to evaluate the effectiveness of three months of high dose Rifapentine and Isoniazid (3HP) administered as a once-weekly dose (12 weekly doses) against a regular six month IPT course; the study also compares the effectiveness (pragmatic trial) of one course of 3HP to a pulsed annual repeat course of 3HP.
In the second year of CTB, all clinical trial activities to compare the effect of three months of high dose Isoniazid and Rifapentine (3HP) administered as a single round or given as two annual rounds in HIV-infected individuals were geared towards initiating participant enrollment in early Year 3. These activities included the signing of a KNCV sub-agreement with the Aurum Institute, establishment of a Trial Steering Committee, a first planning meeting in December 2015, as well as agreements with Sanofi and Qiagen for donation of drugs and IGRA tests.
Global Fund Hub
A key strategic objective of Challenge TB was to support timely and successful implementation of Global Fund (GF) grants within the 24 Challenge TB countries. The approach taken to support GF grant implementation at the country level varied depending on need, but a common theme consisting of collaboration, information sharing, leveraging of resources and technical support was applied across the board.
The primary role of this project was to ensure that Challenge TB contributes to successful implementation of GF grants in the countries it operates. This was done through building on previous experiences to coordinating technical assistance and to make it even more efficient, as well as the active monitoring GF grant performance and direct support to identify bottlenecks and local solutions to improve performance.
A general mapping exercise and survey were completed to give an overall picture of GF grant performance in the 21 countries where CTB operates. In addition, the GF Hub is focused on getting CTB countries ready for the new funding cycle that will start in 2017.