Accelerating Universal Health Coverage for vulnerable populations in Ukraine and Armenia
The impact of operational research on public health programmes addressing HIV, TB and child mortality
“Despite current programme achievements, reaching undiagnosed people who inject drugs and linking them to care for both TB and HIV remains a challenge.” – Anton Basenko, Ukrainian Network of People Who Use Drugs
Operational research improves and supports sustainable scale-up of health programmes, particularly for vulnerable populations that may be missed by routine public health systems. Operational research therefore contributes to achieving universal health coverage (UHC) so no-one is left behind. The Structured Operational Research IniTiative (SORT IT) is a global partnership-based initiative coordinated by TDR that builds sustainable operational research capacity in countries.
SORT IT training courses funded by USAID and led by alumni of previous SORT IT courses were held in Ukraine (Dr Olga Denisiuk) and Armenia (Dr Karapet Davtyan) and have led to the publication of 18 operational research studies in two special issues of the Journal of Infection in Developing Countries.
The research and trainings have been conducted in collaboration with the WHO Regional Office for Europe in the context of the European TB Research Initiative (ERI-TB). Findings from these studies are already making an impact on programmes. For example:
- The research findings are being used to optimize current programmes funded by the Global Fund and PEPFAR in Ukraine.
- The WHO Regional Office for Europe is taking up the study findings, which are informing the implementation of the Roadmap to Implement the Tuberculosis Action Plan for the WHO European Region 2016–2020.
SORT IT alumni from these studies are also leading UHC-related work in 12 other countries in Eastern Europe and Central Asia.
Below are some research highlights from the two special issues.
- Strategies for active detection of tuberculosis amongst key populations in Ukraine, Kamenska N et al  Study findings: Introducing active TB case finding in about 700,000 people from key populations significantly increased TB detection, with 90% of detected cases starting TB treatment. The TB detection rate was 13 times higher when screening for symptoms and specimen collection was decentralized to outreach sites.   Implications: Active TB case finding among key populations will increase detection of TB cases and their linkage to care. This is important to reach those who lie outside the realms of routine health services, avoid missed TB cases and reduce community transmission. Resource mobilisation is needed to embed this strategy into TB programmes.
- Tuberculosis care services in Armenia: what has changed since the 2014 reform?, Lylozian H et al   Study findings: The financing mechanism for TB care was reformed in 2014 to avoid unnecessary hospitalizations for TB patients. As a result, hospital admissions declined by 76% (from 6513 in 2013 to 1560 in 2017), and the average hospitalisation period declined by 33%. There were considerable cost savings.  Implications: The 2014 TB reform fostered an ambulatory approach to TB management, improved bed-availability, reduced hospitalisation costs four-fold in four years (from US$ 247,038 to US$ 59,170) and reduced the likelihood of TB transmission.
- Engaging people who inject drugs and their peers in HIV testing and harm reduction in Ukraine: do they make a difference? , Kravchenko N et al.   Study findingss: HIV testing increased by over 300% (from 164,417 to 639,685) and significantly more HIV-positive individuals were identified and referred for harm-reduction services. An operational challenge was that harm reduction services became overwhelmed, with observed declines in enrolment.  Implications: Active engagement of people who inject drugs and their peers makes a real difference in improving their opportunity to access HIV prevention and harm reduction services. There is a need for parallel investments in harm reduction to accommodate enrolments pouring in from HIV testing.
- Free hospitalisation for acute respiratory infections in children: what effect and how much does it cost in Armenia?, Sargsyan S et al.   Study findings: Free hospitalization increased access to hospital admissions by 75% in infants and 85% in children. There was an accompanying 19% decline in infant mortality and 11% decline in under-five mortality, respectively. However, the costs of hospitalizations in Armenia increased by 57% (from 2.1 to 3.3 billion Armenian drams).  Implications: Offering free hospitalisations improved access to care with favourable declines in infant and under-five mortality. New sources of funding are needed to sustain the gains.
TDR is able to conduct its work thanks to the commitment and support from a variety of funders. These include our long-term core contributors from national governments and international institutions. USAID has contributed designated funding for the SORT IT initiative in Ukraine and Armenia. For the full list of donors, please visit https://www.who.int/tdr/about/funding/funders/en/.
For more information, contact: Makiko Kitamura TDR Communications Officer E-mail: firstname.lastname@example.org.