Ghana: TIME modelling for reprogramming
In Ghana we established a close relationship with the NTP and the Global Fund Country Team to provide on-going technical support. TIME Impact was used to model the current TB epidemic following the 2013 prevalence survey and assess the likely impact of the proposed interventions from the National Strategic Plan. Modelling results were used to guide reprogramming of the Global Fund grant to make the case for an increase in coverage of case-finding activities and assess the achievability of the notifications targets from the Global Fund Performance Framework.
Collaboration with the Ghanaian NTP is on-going and driving data collection, through an assessment of catastrophic costs and evaluation of the impact of case-finding activities in health care settings.
Figure 1: Impact of case finding strategy on TB notification rate in Ghana
Table 1: Model calibration to Ghana epidemiological data
|Notifications rate (per 100,000)||61.9||60.3|
|Prevalence rate (per 100,000)||290 (113-548)||312|
|Incidence rate (per 100,000)||168 (81-286)||167|
|Mortality rate (per 100,000)||52 (24.8-88)||64.6|
|% prevalence MDR (treatment naïve)||1.9 (0.1-5.3)||2.9|
|% prevalence MDR (retreatment)||20 (0.1-40)||13.7|
|15+ HIV prevalence||1.5 (1.2-2.0)||1.34|
|ART coverage||32 (24-41)||27.5|
South Africa: TIME modelling to rationalise policy
In 2014 the South Africa TB Think Tank was set up, bringing together policymakers, the NTP, academics, NGOs and funders in order to address short and long-term policy questions. TIME modelling has been a central tool to this Think Tank, and was an integral part of developing the first joint TB and HIV Investment Case, which was presented to the NDOH, rationalising the choice of ICF and the provision of IPT to PLHIV on ART and guiding TB operational research priorities in South Africa.
TIME is being used on the provincial level. Through a programme of training and workshops, policymakers in each province now have access to a TIME model that is calibrated to their specific epidemiology and a within-country support network for using TIME to address questions at the appropriate sub-national policy level.
Africa Regional Workshops
In 2016, we held two TIME training workshops for African regional TB policymakers from Ethiopia, Ghana, Malawi, Nigeria, Tanzania and Zambia. The inital workshop (held in Abuja, Nigeria, February 2016) was the first step of a longer training pathway to increase the capacity within countries to make informed choices about the use of TIME in their policy cycles. As part of this pathway participants are offered support by the TIME team after the workshop, as they develop their skills by addressing a specific policy relevant question, and involve other actors in the local TB response. A follow up workshop (held in Addis Ababa, Ethiopia, June 2016) focused on introducing other TIME functionalities (e.g. costing and OneHealth), and discussing the progress made by country teams on their country specific work.
The workshop reports are available to view here: