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TB Notes 1, 2001
Updates from the Research and Evaluation Branch
The Global Alliance for TB Drug Development
After several decades of neglect, TB is receiving the increased
attention that this global public health problem deserves. Governments,
nongovernmental organizations, and philanthropic organizations are
beginning to invest the major sums of money required to control
and eventually eliminate this ancient scourge. Although most of
these new resources are appropriately being invested in the TB control
programs of countries where the epidemic is most severe, a significant
commitment is also being made to develop new diagnostic, treatment,
and prevention tools, including new drugs. Until now, progress in
anti-TB drug development has been impeded by two major factors:
the belief that there was little need for new agents and the high
cost of drug development. These caused the perception that the potential
global market was insufficient to guarantee return on investment.
To address these problems, a number of interested parties, with
initial support from the Rockefeller Foundation, have created the
Global Alliance for TB Drug Development (GATB), a not-for-profit
venture that will accelerate the discovery and development of new
drugs to fight tuberculosis. It is one of a new breed of public-private
partnerships that pursues a social mission by employing the best
practices of the private sector and draws upon resources from both
the public and private realms. The vision of GATB is the provision
of new medicines with equitable access for the improved treatment
of tuberculosis. Its mission is to accelerate discovery and development
of cost- effective new drugs that will shorten the duration of treatment
or otherwise simplify its completion, provide for more effective
treatment for MDR TB, and improve the treatment of latent TB infection.
GATB functions as a lean, virtual research and development organization
that subcontracts projects to public or private partners. It will
selectively intervene when its actions will help move a drug candidate
towards registration and use in therapy, and, thus, build a portfolio
of projects with varying levels of funding, management, and ownership.
To be successful, this will require continued and increased support
by national and international health organizations, private sector
pharmaceutical and biotechnology companies, and foundations. By
combining our resources, GATB and its partners can make a vitally
important contribution to improved control and the eventual elimination
of TB from every country of this world. Use the link for more information
on the GATB.
-Reported by Richard J. O'Brien, MD
Division of TB Elimination
Training in Prevention Effectiveness and Program Evaluation
The Prevention Effectiveness Section (PES), within the Research
and Evaluation Branch, conducts a variety of studies using a wide
range of research methods, including decision and economic analyses,
behavioral and social research techniques, and program evaluation
tools. Recognizing the growing importance of these methods, PES
has undertaken two training initiatives to help increase the skills
and capacity of state and local TB program staff to conduct prevention
effectiveness and program evaluation studies.
Prevention Effectiveness: Over the last few years, CDC's Epidemiology
Program Office (EPO) has developed and delivered two prevention
effectiveness training courses, which consist of a series of didactic
lectures and small-group case study discussions. One course focuses
on decision and economic analyses (such as cost-benefit, cost-effectiveness,
and cost-utility analyses), and the other focuses on cost analysis.
During 2000, PES held two 2-day courses on how to use decision and
cost-effectiveness analyses: one for 24 state and local TB staff
members in Berkeley, California, in June, and the other for 29 state
disease control staff members in Augusta, Maine, in October.
In early February 2001, PES collaborated with EPO to conduct a
2-day course on cost analysis for 25 state and regional disease
control staff members in Columbia, South Carolina. The course is
also being developed into a print-based, self-study module with
a TB case study, which will be pretested this summer. If you would
like to pretest the module, please contact PES at (404) 639-8123.
Program Evaluation: In September 1999, CDC published the report
Framework for Program Evaluation in Public Health, MMWR
1999:48(No. RR-11). This can be accessed on-line at http://www.cdc.gov/mmwr/indrr_99.html.
This framework provides a six-step process for public health programs
to use in evaluating their interventions and operations, and provides
a systematic way for diverse programs to effectively and systematically
conduct evaluations. Understanding how to apply the framework to
a TB program requires evaluation skills.
PES collaborated with an experienced contractor to develop and
produce a TB-specific training course to introduce program evaluation
methods to state and local TB program staff. The course introduces
participants to the basic principles of evaluation and walks them
through the six-step evaluation process. Course participants work
through several TB case studies to illustrate concepts such as developing
a logic model and selecting an evaluation design.
On February 1 and 2, 2001, a train-the-trainer course was held
to create a cadre of evaluators-trainers within DTBE. Feedback from
the course was overwhelmingly positive, and generated additional
suggestions for improvements, which will be incorporated into future
courses. PES is currently in the process of finalizing the comprehensive
2-day course for replication in other settings, adapting sections
of the course for a 4-hour skill-building session on logic modeling,
and developing a 2-hour introduction to evaluation principles.
If you would like more information about the prevention effectiveness
or program evaluation training courses, please contact Dr. Noreen
Qualls or Ms. Maureen Wilce, respectively, at (404) 639-8123.
-Reported by Noreen Qualls, PhD,
and Maureen Wilce, MS
Division of TB Elimination