Annual Report 2008 - 2009 - Liverpool School of Tropical Medicine

CLINICAL
GROUP
FINDING SOLUTIONS FOR THE
PROBLEM OF POVERTY IN TB CONTROL
The Collaboration for Research on Equity and
Systems for TB and HIV/AIDS (CRESTHA) at LSTM,
has this year continued to support pragmatic
trials of health system interventions aimed at
improving access by the poor to TB services. The
Triage-Plus work with informal providers (featured
in the 2006/07 Annual Report) has continued in
Sudan and Malawi with valuable support from the
Norwegian Heart & Lung Patient Organisation. A
new trial is also now underway in Hunan Province
in China. This is testing the effect on TB case
notifications of removing up-front, out-of-pocket
payments for health services from patients with
chronic cough symptoms. Instead of patients
having to pay up-front and then be reimbursed
later by China’s New Co-operative Medical
Scheme (NCMS), the NCMS is directly covering
costs incurred by TB dispensaries in two counties
(Lingxiang and Miluo). A third, similar county
(Huarong) is acting as a control.
LSTM operates the Secretariat of the TB & Poverty
Subgroup and this facilitates our ability to reach
a global audience for the policy and practice
implications of our work.
This year the Secretariat has been championing
a call for consultations and tests for patients with
chronic cough symptoms to be free of charge
at the point of access. The Secretariat hosted a
debate within the Global Stop-TB Partnership
Forum in Rio De Janeiro entitled ‘A TB-Free World
requires Free TB diagnosis’ and the resulting
recommendation was included in the Rio
Declaration on TB control. Another achievement
this year has been the contribution of a chapter
on Access and Impact Assessment in the Scientific
Blueprint for Development of New Diagnostics.
CRESTHA was amongst a team of partners led by
The International Union Against Tuberculosis and
Lung Disease in a successful bid to the United
States Agency for International Development
(USAID) for a multi-million dollar, five-year
collaborative research grant named TREAT-TB
(Technology, Research, Education And Technical
Assistance for Tuberculosis). CRESTHA will be
responsible for the impact evaluation of this
work – principally on the extent to which the
new interventions serve the needs of the poor
and facilitate progress towards the Millennium
Development Goals. The first years of research are
focusing on field evaluations of new diagnostic
tests for TB.
PROFESSOR DAVID LALLOO MB BS MD FRCP FFTM RCPS (Glasg)
HEAD OF CLINICAL RESEARCH GROUP
CLINICAL DIRECTOR AND PROFESSOR IN CLINICAL TROPICAL MEDICINE
DIRECTOR OF WELLCOME TRUST LIVERPOOL TROPICAL CENTRE
David’s main research interests are in clinical trials and epidemiological studies in resource poor
settings, particularly in HIV related infections, malaria and envenoming. He has collaborations
and studies in a number of countries including Uganda, Malawi, Sri Lanka and Vietnam. He
holds an appointment as Honorary Consultant at the Royal Liverpool University Hospital.
12 LSTM ANNUAL REPORT