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Free Content Making innovations accessible to the poor through implementation research [State of the art series. Operational research. Number 7 in the series]

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Within countries, poorer populations have greater health needs and less access to good medical care than better-off populations. This is particularly true for tuberculosis (TB), the archetypal disease of poverty. Innovations also tend to become available to better-off populations well before they become available to those who need them the most. In a new era of innovations for TB diagnosis and treatment, it is increasingly important not only to be sure that these innovations can work in terms of accuracy and efficacy, but also that they will work, especially for the poor. We argue that after an innovation or a group of innovations has been endorsed, based on demonstrated accuracy and/or efficacy, introduction into routine practice should proceed through implementation by research. Cluster-randomised pragmatic trials are suited to this approach, and permit the prospective collection of evidence needed for full impact assessment according to a previously published framework. The novel approach of linking transmission modelling with operational modelling provides a methodology for expanding and enhancing the range of evidence, and can be used alongside evidence from pragmatic implementation trials. This evidence from routine practice should then be used to ensure that innovations in TB control are used for positive action for all, and particularly the poor.
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Keywords: access; innovation; poverty; research; tuberculosis

Document Type: Review Article

Affiliations: 1: Collaboration for Research on Equity and Systems in TB and HIV-AIDS (CRESTHA), Clinical Research Group, Liverpool School of Tropical Medicine, Liverpool, UK 2: United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland 3: KNCV Tuberculosis Foundation, The Hague, The Netherlands; and Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Centre, Amsterdam, The Netherlands 4: Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi 5: REDE TB, Academic Tuberculosis Program, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil 6: International Union Against Tuberculosis and Lung Disease, Paris, France 7: Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Centre, Amsterdam, The Netherlands

Publication date: July 1, 2011

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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