Data for action: collection and use of local data to end tuberculosis

Abstract

Accelerating progress in the fight against tuberculosis will require a drastic shift from a strategy focused on control to one focused on elimination. Successful disease elimination campaigns are characterised by locally tailored responses that are informed by appropriate data. To develop such a response to tuberculosis, we suggest a three-step process that includes improved collection and use of existing programmatic data, collection of additional data (eg, geographic information, drug resistance, and risk factors) to inform tailored responses, and targeted collection of novel data (eg, sequencing data, targeted surveys, and contact investigations) to improve understanding of tuberculosis transmission dynamics. Development of a locally targeted response for tuberculosis will require substantial investment to reconfigure existing systems, coupled with additional empirical data to evaluate the effectiveness of specific approaches. Without adoption of an elimination strategy that uses local data to target hotspots of transmission, ambitious targets to end tuberculosis will almost certainly remain unmet.

Figure 1. Geographic hot-spots of MDR-TB risk in the Republic of Moldova

Colors represent the proportion of previously treated TB cases with drug susceptibility testing data that are multidrug-resistant by location of residence. Maps such as this – which can help target intervention efforts and direct future research – represent the product of strengthening multiple aspects of the TB surveillance system. In the early 2000s, Moldova’s TB program updated the laboratory network, revised guidelines and improved training to ensure universal drug susceptibility testing. Standardized reporting systems facilitated more complete and accurate reporting of TB incidence, outcomes and drug resistance, and a nationwide online database was introduced with access at every national TB facility. Physicians and laboratory staff enter data on individual TB patients (including routinely collecting location of residence) in real time at the relevant points of contact. Data are then synthesized into detailed maps of TB and drug-resistant TB, such as the one presented here, which can in turn be used to focus resources and efforts on regions of likely high ongoing transmission of drug-resistant TB (such as certain locales in the southeast represented in orange and red). Reproduced with permission of the European Respiratory Society: Eur Respir J November 2013 42:1291–1301. This material has not been reviewed by the European Respiratory Society prior to release; therefore the European Respiratory Society may not be responsible for any errors, omissions or inaccuracies, or for any consequences arising there from, in the content.

Figure 2. Structuring Data and Decision Making for TB Elimination

Existing structures largely consist of data that are sent from the local level and aggregated at the central level for purposes of reporting and broad target-setting, with decisions made in top-down fashion and rarely involving individuals below the regional or district level (Panel A). In order to achieve TB elimination, data structures and decision-making should arguably be centered on activities the local level, which is the level at which TB transmission occurs. Such structures should support data and decision-making that is bidirectional and mutually informative in nature, involving all levels of the TB control system (Panel B). This flow of information should not only occur between healthcare system tiers, but also between localities, in order to disseminate information about what works in different settings. NTP = National Tuberculosis Program, MoH = Ministry of Health.