Tuberculosis (TB) is one of the world’s greatest global public health challenges and drug-resistant TB poses a particularly persistent threat. TB incidence and mortality rates declined over last two years in Europe, and similar trends were observed in Georgia. Nevertheless, TB drug resistance, low rates of case detection and treatment adherence, as well as systems level issues such as low coordination between TB and general primary care services and the low motivation of TB healthcare providers, all pose critical challenges in successful TB management.
Curatio International Foundation in partnership with Queen Margaret University (UK), the London School of Hygiene and Tropical Medicine (UK) and the Antwerp Institute of Tropical Medicine (Belgium) is implementing a four-year research project to study the impact of an integrated care model and a results-based financing scheme on adherence to TB treatment at the outpatient level.
The project is funded through the Joint Health Systems Research Initiative which is jointly funded by the Department of International Development (DFID), the Economic and Social Research Council (ESRC), the Medical Research Council (MRC) and the Wellcome Trust (WT).
The research team, in collaboration with the policymakers and other national stakeholders, assisted the Government of Georgia in the intervention design. The intervention implies the establishment of integrated, multidisciplinary TB treatment at the PHC level with a provider Results-Based Financing (RBF) scheme to ensure patient-centered, comprehensive care at the outpatient level. More details on the intervention are provided on the page. “About the Rusults4TB intervention”.
The research will explore the impact of the intervention on adherence to the TB treatment and treatment success rates. Health economic and realist evaluation components will explore the cost-effectiveness of the proposed intervention and its effects on TB management and provider behavior. The mechanisms of change and the contextual factors that enhance or undermine the effectiveness of the intervention will be observed.
The intervention will be piloted in ten randomly selected TB outpatient facilities and will be controlled in another ten TB facilities throughout the country over a 24 month period.
More specifically, the research will answer the following questions:
- What is the impact of the intervention on patient adherence to tuberculosis treatment and treatment outcomes of both Drug-Susceptible and Drug-Resistant patients in Georgia?
- Is the intervention cost-effective?
- How does it work, for whom and in which conditions?
- How should the intervention, including the RBF model, be modified to optimize the national roll-out for this and possibly other health services?
The research project will be implemented from March 2017 to February 2021.