Tuberculosis Interventions in Developing Countries Lack Documentation

--by Jenara Nerenberg

The Gist

Tuberculosis (TB) is a challenging communicable disease to contain, and while bodies such as the World Health Organization and the Gates Foundation have poured much time and money into the disease's prevention and treatment, countries have struggled to make improvements.

A new study published this week in PLOS Medicine indicates that studies on the effectiveness of TB interventions in real-world, low-resource settings are sparse, and that useful data is missing about what works in day-to-day TB management on a programmatic level. 

Frank Cobelens from the Amsterdam Institute of Global Health and Development in the Netherlands led this systematic literature review.

"The conclusion of our study is not that TB interventions are less effective than previously thought, but that few studies have been done to see if they are effective when implemented in day-to-day health practice," Cobelens tells Healthline.

The Expert Take

"While there has generally been ample evidence to show that [TB interventions] work under ideal conditions, little data is available to show how these should be tailored to national and local conditions in order to make them work in real life," says Cobelens.

Lack of data can misinform policy, and hence, better data is needed to guide policy and effectively design TB interventions.

"There is a paucity of operational data about implementation aspects for these interventions, and policy makers will often not be convinced that the intervention will do more good than harm and/or is cost-effective and affordable when rolled-out in their countries," Cobelens says.

The Takeaway

TB is a tenacious disease, and policy makers and public health professionals should take seriously the need to document the effectiveness of individual interventions. 

"What policy makers should do is to encourage pilots of these interventions and the operational research to go with them to assess how they are implemented to their best effect, what it would cost, and how they are best tailored to local conditions. In addition, policy makers, both at the national and global level, should make sure that capacity (human and financial) exists to do such studies," Cobelens concludes. 

Source and Method

Cobelens and his colleagues examined 208 studies to assess evidence of intervention effectiveness and to look at the settings in which such interventions were implemented. Their findings reveal that there are few real-world studies on the effectiveness of TB interventions, and that many of the existing studies were conducted in controlled research settings. Methods, implementation, delivery, and operational issues also need to be better reported, the study finds.

Other Research

TB interventions have taken many forms, from working with native healers to having rural community health workers use mobile phones to document the progress of the disease. A 2006 study published in AIDS and Behavior found that many traditional healers are willing to refer at-risk individuals to formal medical practitioners, but that no higher levels of referrals actually took place after the study period.

A 1995 study published in the Annals of Internal Medicine found that implementing particular control measures in a hospital setting reduced the transmission of multi-drug-resistant TB. And a 2002 study from the International Journal of Tuberculosis and Lung Disease found that focusing on preventive therapy is effective in reducing transmission of the disease.