Journal Article > CommentaryFull Text
Public Health Action. 21 September 2014; Volume 4 (Issue 3); DOI:10.5588/pha.14.0028
Zachariah R, Kumar AMV, Reid A, Van der Bergh R, Isaakidis P, et al.
Public Health Action. 21 September 2014; Volume 4 (Issue 3); DOI:10.5588/pha.14.0028
Journal Article > ResearchFull Text
Int J Tuberc Lung Dis. 6 September 2011; Volume 15 (Issue 11); DOI:10.5588/ijtld.11.0503
Harries AD, Lin YD, Satyanarayana S, Lonnroth K, Li L, et al.
Int J Tuberc Lung Dis. 6 September 2011; Volume 15 (Issue 11); DOI:10.5588/ijtld.11.0503
The prevalence of diabetes mellitus is increasing at a dramatic rate, and countries in Asia, particularly India and China, will bear the brunt of this epidemic. Persons with diabetes have a significantly increased risk of active tuberculosis (TB), which is two to three times higher than in persons without diabetes. In this article, we argue that the epidemiological interactions and the effects on clinical presentation and treatment resulting from the interaction between diabetes and TB are similar to those observed for human immunodeficiency virus (HIV) and TB. The lessons learned from approaches to reduce the dual burden of HIV and TB, and especially the modes of screening for the two diseases, can be adapted and applied to the screening, diagnosis, treatment and prevention of diabetes and TB. The new World Health Organization (WHO) and The Union Collaborative Framework for care and control of TB and diabetes has many similarities to the WHO Policy on Collaborative Activities to reduce the dual burden of TB and HIV, and aims to guide policy makers and implementers on how to move forward and combat this looming dual epidemic. The response to the growing HIV-associated TB epidemic in the 1980s and 1990s was slow and uncoordinated, despite clearly articulated warnings about the scale of the forthcoming problem. We must not make the same mistake with diabetes and TB. The Framework provides a template for action, and it is now up to donors, policy makers and implementers to apply the recommendations in the field and to 'learn by doing'.
Journal Article > CommentaryFull Text
Lancet. 29 May 2010; Volume 375 (Issue 9729); DOI:10.1016/S0140-6736(10)60409-6
Harries AD, Zachariah R, Corbett EL, Lawn SD, Santos-Filho ET, et al.
Lancet. 29 May 2010; Volume 375 (Issue 9729); DOI:10.1016/S0140-6736(10)60409-6
Despite policies, strategies, and guidelines, the epidemic of HIV-associated tuberculosis continues to rage, particularly in southern Africa. We focus our attention on the regions with the greatest burden of disease, especially sub-Saharan Africa, and concentrate on prevention of tuberculosis in people with HIV infection, a challenge that has been greatly neglected. We argue for a much more aggressive approach to early diagnosis and treatment of HIV infection in affected communities, and propose urgent assessment of frequent testing for HIV and early start of antiretroviral treatment (ART). This approach should result in short-term and long-term declines in tuberculosis incidence through individual immune reconstitution and reduced HIV transmission. Implementation of the 3Is policy (intensified tuberculosis case finding, infection control, and isoniazid preventive therapy) for prevention of HIV-associated tuberculosis, combined with earlier start of ART, will reduce the burden of tuberculosis in people with HIV infection and provide a safe clinical environment for delivery of ART. Some progress is being made in provision of HIV care to HIV-infected patients with tuberculosis, but too few receive co-trimoxazole prophylaxis and ART. We make practical recommendations about how to improve this situation. Early HIV diagnosis and treatment, the 3Is, and a comprehensive package of HIV care, in association with directly observed therapy, short-course (DOTS) for tuberculosis, form the basis of prevention and control of HIV-associated tuberculosis. This call to action recommends that both HIV and tuberculosis programmes exhort implementation of strategies that are known to be effective, and test innovative strategies that could work. The continuing HIV-associated tuberculosis epidemic needs bold but responsible action, without which the future will simply mirror the past.
Journal Article > CommentaryFull Text
Trop Med Int Health. 12 August 2013; Volume 18 (Issue 9); DOI:10.1111/tmi.12159
Harries AD, Zachariah R, Maher D
Trop Med Int Health. 12 August 2013; Volume 18 (Issue 9); DOI:10.1111/tmi.12159
Journal Article > CommentaryFull Text
Int J Clin Pract. 15 July 2011; Volume 65 (Issue 8); DOI:10.1111/j.1742-1241.2011.02697.x
Maher D, von Schoen-Angerer T, Cohn J
Int J Clin Pract. 15 July 2011; Volume 65 (Issue 8); DOI:10.1111/j.1742-1241.2011.02697.x
Journal Article > CommentaryFull Text
Lancet Infect Dis. 9 February 2012; Volume 26 (Issue 5); DOI:10.1097/BOT.0b013e318225e8d0
Zachariah R, Ford NP, Maher D, Bissell K, Van der Bergh R, et al.
Lancet Infect Dis. 9 February 2012; Volume 26 (Issue 5); DOI:10.1097/BOT.0b013e318225e8d0
Operational research in low-income countries has a key role in filling the gap between what we know from research and what we do with that knowledge-the so-called know-do gap, or implementation gap. Planned research that does not tangibly affect policies and practices is ineffective and wasteful, especially in settings where resources are scarce and disease burden is high. Clear parameters are urgently needed to measure and judge the success of operational research. We define operational research and its relation with policy and practice, identify why operational research might fail to affect policy and practice, and offer possible solutions to address these shortcomings. We also propose measures of success for operational research. Adoption and use of these measures could help to ensure that operational research better changes policy and practice and improves health-care delivery and disease programmes.
Journal Article > ReviewFull Text
Trop Med Int Health. 8 February 2013; Volume 18 (Issue 4); DOI:10.1111/tmi.12075
Ford NP, Maher D
Trop Med Int Health. 8 February 2013; Volume 18 (Issue 4); DOI:10.1111/tmi.12075
Journal Article > CommentaryFull Text
BMC Public Health. 22 September 2009; Volume 9 (Issue 1); DOI:10.1186/1471-2458-9-355
Maher D, Harries AD, Zachariah R, Enarson D
BMC Public Health. 22 September 2009; Volume 9 (Issue 1); DOI:10.1186/1471-2458-9-355
BACKGROUND: Although in developing countries the burden of morbidity and mortality due to infectious diseases has often overshadowed that due to chronic non-communicable diseases (NCDs), there is evidence now of a shift of attention to NCDs. DISCUSSION: Decreasing the chronic NCD burden requires a two-pronged approach: implementation of the multisectoral policies aimed at decreasing population-level risks for NCDs, and effective and affordable delivery of primary care interventions for patients with chronic NCDs. The primary care response to common NCDs is often unstructured and inadequate. We therefore propose a programmatic, standardized approach to the delivery of primary care interventions for patients with NCDs, with a focus on hypertension, diabetes mellitus, chronic airflow obstruction, and obesity. The benefits of this approach will extend to patients with related conditions, e.g. those with chronic kidney disease caused by hypertension or diabetes. This framework for a "public health approach" is informed by experience of scaling up interventions for chronic infectious diseases (tuberculosis and HIV). The lessons learned from progress in rolling out these interventions include the importance of gaining political commitment, developing a robust strategy, delivering standardised interventions, and ensuring rigorous monitoring and evaluation of progress towards defined targets. The goal of the framework is to reduce the burden of morbidity, disability and premature mortality related to NCDs through a primary care strategy which has three elements: 1) identify and address modifiable risk factors, 2) screen for common NCDs and 3) and diagnose, treat and follow-up patients with common NCDs using standard protocols. The proposed framework for NCDs borrows the same elements as those developed for tuberculosis control, comprising a goal, strategy and targets for NCD control, a package of interventions for quality care, key operations for national implementation of these interventions (political commitment, case-finding among people attending primary care services, standardised diagnostic and treatment protocols, regular drug supply, and systematic monitoring and evaluation), and indicators to measure progress towards increasing the impact of primary care interventions on chronic NCDs. The framework needs evaluation, then adaptation in different settings. SUMMARY: A framework for a programmatic "public health approach" has the potential to improve on the current unstructured approach to primary care of people with chronic NCDs. Research to establish the cost, value and feasibility of implementing the framework will pave the way for international support to extend the benefit of this approach to the millions of people worldwide with chronic NCDs.