1. Operational research around Tuberculosis South-Kivu Province, DRC Emmanuel ANDRE, MD, PhD candidate UCL/SSS/IREC/MBLG

2. Principal caracteristics Wars since 1993 (850.000 internally displaced persons in march 2012, cholera epidemics, armed groups, sexual violence,...) Highly mobile high risk groups (soldiers, artisanal miners,...) 65.000 km2 (Belgium : 30.500 km2) 34 health zones, 78 TB health facilities

3. Operational reserach All about solving problems... Operational research (OR) encompasses a wide range of problem-solving techniques and methods applied in the pursuit of improved decision-making and efficiency (Wikipedia, August 2012)

4. Problem 1: TB detection Solution 1: TB patients, PCR

5. What WHO says...

6. SS+ cases detected

7. Baseline & Target South-Kivu Population SS+ Incidence new SS+ cases/100. 000 Expected SS+ cases SS+ Detected and treated cases (2010) SS+ not cured cases (2010) SS+ undected cases 5.800.0001508.7002.6153926.085 In 1 year : Find 2.000 additional cases (+76%)

8. Strategies proposed Increase general awareness about TB (media, former TB patients) Active case finding of TB suspects (former TB patients) Increase the sensibility of lab diagnosis (PCR) 2.000 additional TB cases detected and treated

9. Problem 2: Funds Solution 2: TB Reach initiative

10. TB Reach TB REACH is an initiative of the Stop TB Partnership (WHO). Promotes early and increased TB case detection among poor, vulnerable and at-risk populations The second wave of TB REACH funding was announced on 1 December 2010 with a deadline of 28 February 2011 for proposal submission. Budget needed : 750.000 USD In March 2011 the TB REACH Proposal Review Committee (PRC) selected 45 projects for funding from among 318 applications

11. Problem 3: HR Solution 3: Teach

12. Former TB patients Former TB patients (poor people, often co-infected with HIV, fear of stigma,...) Performance based financing (3 USD/new SS+ case found) Some former TB patients start getting money from their work. TB starts being an oportunity...

13. Lab technicians, MD... 40 lab technicians trained to PCR techniques (Genexpert) At the «source» (lab tech school, medical schools,...) Performance based financing (1 USD/additional TB case) Reinforcement of Quality Control

14. Problem 4: PCR Solution 4: «Article 15»

15. Genexpert MTB/Rif Detects 72,5% of Culture+/SS- samples (NEJM, 2010) Turnaround time = 2h 8 machines, 10.000 tests (280.000 USD)

16. Electricity only a few hours per day Car battery system 8h autonomy

17. Problem 5: Impact Solution 5: M&E

18. Former TB patients Q1Q2Q3Q4 TB centers with groups implemented +13%+55% ?? TB centers with no groups implemented +18%+13% ?? Province+16%+31% ? +76% ? SS+ notification compared to baseline 40 Groups created to date

19. The work of TB patients...

20. Genexperts

21. Yield (June 2012) September 2012 : 3000 tests performed

22. Problem 6: Reference Solution 6: Mobility of samples

23. Transfered samples

24. Alcool conservation 1/1 Ethanol dilution Better conservation 4 days -> 1 month High temperature Lower biohazard risk

25. Conclusions New problems always come New (and innovative) solutions always come Data come Is this research?

26. Thanks! Prof. M. Delmée CIDMED South-Kivu TB Team...