Although tuberculosis (TB) has existed for thousands of years, new tools for diagnosing and treating it are quickly changing the way in which countries plan TB care and treatment programs. The National Tuberculosis Programs (NTPs) in most low-income countries depend heavily on international donor funding.
With recent declines in foreign assistance, however, increased awareness about the importance of designing sustainable programs is critical. The USAID-funded SIAPS Program recently worked with two countries to assess the short and long-term costs of implementing new diagnostics for TB.
Because the symptoms of TB are similar to the symptoms of other diseases, diagnosis usually depends on laboratory testing. For the past few decades healthcare workers in much of the world relied upon a TB test that, while inexpensive, cannot determine whether a strain of TB is resistant to Rifampicin, one of the primary medicines used to treat TB. Since drug resistant (DR)-TB requires a treatment regimen that’s more expensive, longer, and more toxic than treatment for drug sensitive TB, testing for Rifampicin resistance is key to curing individuals with DR-TB and halting its spread.
The development of a new diagnostic called GeneXpert MTB/RIF has the potential to change the way TB is diagnosed and treated. In the span of two hours GeneXpert simultaneously diagnoses TB and tests for resistance to Rifampicin. While this development holds great potential for patients, NTPs need to be able to budget for the added costs of adopting new tools. With the ability to diagnose DR-TB that might otherwise have gone undetected, GeneXpert will likely lead to a rise in the number of required DR-TB treatments. Increased treatment expenses are one piece of a number of downstream costs that NTPs must budget for when planning for implementation of a new diagnostic.
SIAPS recently designed an efficient approach to assessing the costs of rolling out new TB diagnostics. Working with the NTPs in Rwanda and Uganda, SIAPS applied this approach to assess each country’s GeneXpert scale-up plans. Over the course of three months, SIAPS collaborated with key TB stakeholders in each country to synthesize documents from the NTP and Ministry of Health (MOH), as well as literature on the cost and financing of TB diagnostics and treatment in each country. Because countries often follow slightly different algorithms when diagnosing TB, the costs associated with the rollout of a new diagnostic are often specific to country context.
During the course of the assessment, both countries provided valuable insights on differences in the decision-making processes, coordination among partners and key stakeholders, and availability and management of financial sources. It also identified potential gaps in financing.
The assessment revealed that in Uganda the cost of rolling out GeneXpert according to original plans would consume 29 percent of the annual NTP budget. Additionally, while a variety of external agencies planned to provide funding for the GeneXpert machines in Uganda, no financial support had been identified for the cost of consumables, such as the disposable cartridges needed to test samples. Consequently the assessment highlighted the need for the Government of Uganda to plan for the procurement of cartridges through the National Medical Store.
In Rwanda, the assessment revealed that given the projected number of TB cases and expected budget, the overall cost associated with the roll-out of GeneXpert and treatment of TB were substantially greater than the initial estimates by the Rwandan NTP. Because the timing of the assessment corresponded to the drafting of the Extended National Tuberculosis Control Strategic Plan (2013-2016), the NTP was able to incorporate the revised estimates into the total planned budget.
The approach utilized by this assessment underscores the importance of mapping partner activities and funding streams, and identifying treatment-associated costs of new diagnostics. Without this information, NTPs are limited in the extent to which they can plan budgets and options for financing. The ability of NTPs to accurately forecast costs and plan for efficient use of resources will only become more important in the coming years as NTPs assume a greater portion of financing for TB care and treatment.
Read more about what SIAPS is doing to fight TB. [PDF-646KB]