Priority cases for the project and evaluation: New smear positive cases
Definition of treatment success: A new smear positive patient who is successfully treated according to the international definitions (an individual who was smear negative during the last month of treatment and on at least one previous occasion or an individual who has completed treatment but does not meet the criteria to be classified as a cure or failure[1]).
Examples of Activities: Innovative activities for case finding may include, for example, involving the private sector, targeting urban slum areas, enhancing public sector programs (e.g. hospitals, prisons), using incentives/enablers, semi-active case finding (e.g. among household contacts of TB patients).
Classification of access to the DOTS strategy: In order to provide a practical and usable (albeit imperfect) definition of someone with limited access to modern TB control methods, a person with limited access is defined according to the total treatment delay from the onset of symptoms to the initiation of appropriate anti-tuberculosis treatment. If the total treatment delay is 12 weeks or greater the person is classified as having limited access to health services.
Patients seek care in different settings: for tuberculosis control we would wish that individuals with signs compatible with tuberculosis would seek assistance in public health services applying the DOTS strategy showing that they have confidence in that system.
Definition of ‘Additional’: additional to what is likely to have occurred in the absence of fidelis support. This will be determined by comparing the numbers of cases during the duration of the fidelis project with the numbers in the corresponding quarter of the previous year(s). The cost of new structures, establishments, supplies etc. which are proposed to be set up only as an additionality for the fidelis project should be included in the US $80 per additional weighted treatment success as cited on page 2 of the fidelis Request for Proposals. It should be noted that existing structures, establishments, supplies etc. will not be included in the US $80 while calculating the costs of additional weighted treatment success.
Definition of Weighted Treatment Success: an arbitrary comparative value for patients other than those with limited access to health services will be one-half that of a patient from those with limited access to health services.
Because information on accessibility to health care of patients detected in the previous year is often lacking, it is assumed that 50% of previous years' cases were patients with limited access to health care. If reliable data are available on the proportion of cases with limited access to care in previous years, those data can be used instead of the 50% assumption.
The number of weighted treatment successes during the project year compared to the number of weighted treatment successes in the previous year will be used to calculate the projects' additional weighted treatment successes (AWTS).
In assessing the overall cost-effectiveness of the project, the budget divided by the number of AWTS would be use to arrive at the final cost per AWTS.
Example:
For a US $200,000 projects that successfully treats 6,000 patients during the project with 80% designated as limited access and also successfully treats 3000 patients in the previous year with no reliable data on limited access proportions prior to the projects, cost per AWTS calculation would be as follows:
Previous year weighted treatment successes (WTS) = 3000 x 50% (assumption) x 1 + 3000 x 50% x 0.5 = 2250 WTS
Project year WTS = 6000 x 80% x 1 + 6000 x 20% x 0.5 = 5400
AWTS for project = 5400 - 2250 = 3150
Cost per AWTS = 200,000/3150 = US $63.49
A Case Detection and AWTS flow chart will ensure careful consideration of realistic case detection data for all proposal and must be completed by applicants. This flow chart must be completed on the application form (Summary of the Project) and, for purposes of calculation, can be downloaded from the fidelis website as an Excel file. (The fidelis Application Downloads).
The Independent Results Assessment Group uses, for assessment, data from comparator areas, comparing information gathered from this comparator area or group. The Independent Results Assessment Group is responsible for determining:
a) The estimated additional number of treatment successes
i) among people with limited access to health services (the 50% assumption will be applied if no reliable data are available)
ii) among others
b) Intervention area: (baseline) number of treatment successes before the intervention
c) Intervention area: number of treatment successes at the point of measurement (usually first measured 18 months after project start)
d) Comparator area: number of treatment successes before the intervention
e) Comparator area: number of treatment successes at the point of measurement
The Independent Results Assessment Group will use this data to estimate the additional number of treatment successes gained by the program.
[1] Enarson DA, Rieder HL, Arnadottir T, Trebucq A. Management of Tuberculosis. A Guide for Low Income Countries, 5th edition. St-Just-La-Pendue: Compogravure Impression, Broachage Imprimerie. 2000, 91 pages. ISBN 2-914365-00-4