Note: This page summarizes the rationale behind a GiveWell-recommended grant to IRD Global. IRD Global staff reviewed this page prior to publication.
Summary
GiveWell made1 a $262,000 discretionary grant in November 2021 and a follow-up $300,000 grant in April 2022 to IRD Global (IRD) to support its tuberculosis (TB) team in Karachi, Pakistan, from January to December 2022, as we conduct an investigation for potential scale-up funding to its Zero TB program.
The Zero TB approach aims to identify, treat, and prevent TB at scale and in defined geographical boundaries. Initial data suggest that this type of intervention may rapidly improve rates of TB identification followed by rapid reductions in disease notifications.2 We think that maintaining the program team may be beneficial if we decide to recommend a larger grant to IRD’s Zero TB program.
Published: July 2022
Table of Contents
Process
IRD reached out to GiveWell to let us know about a funding shortfall in its Zero TB program after we initiated our investigation. GiveWell recommended this grant via our policy for small discretionary grantmaking. As a small discretionary grant, this funding opportunity did not receive the same review as larger grants we recommend. Instead, we more minimally evaluated the case for the grant and any potential risks or downsides.
Grant activities
This grant will support IRD’s Zero TB team in Karachi, Pakistan, which currently targets high TB burden communities in Karachi. Zero TB aims to create “islands of TB elimination” using a comprehensive “search, treat, prevent” approach.3 This process involves using mobile X-ray equipment, rapid molecular diagnostics, and immunoassays to find and treat active and latent TB cases.4
Case for the grant
We learned that funding for IRD’s Zero TB Team in Karachi would end on December 31, 2021. We think these bridge grants will sustain an experienced team that may support rapid scale up and program success if we decide to fund this project.5 Specifically, IRD expressed concern that this loss would be detrimental to the program’s continued success and potential for scale.6
Risks and reservations
This bridge funding will support IRD’s program as GiveWell completes its review of its Zero TB's program. It’s possible that GiveWell will decide not to fund the program after our full investigation.
Follow-up
We will remain in close contact with the IRD throughout our grant investigation. We expect to complete our investigation in 2022 at which point we will determine whether to recommend a grant to IRD’s Zero TB program.
Sources
- 1
Funding for this grant came from the Effective Altruism (EA) Global Health and Development Fund.
- 2
- “This modeling study suggests that a focused and intensive intervention to halt TB transmission in a high-burden setting, leveraged to also strengthen subsequent TB care by the routine health system, can reduce TB incidence by over 40% (7800 cases averted per million population) and TB mortality by almost two-thirds (1710 lives saved per million population) over a 10-year period.” Shrestha et al. 2021, pg. 12.
- “An increase in the number of DR-TB case notifications in Karachi was observed relative to the years before the intervention. Our study therefore supports existing evidence from other programmatic settings that have reported up to an eight-fold increase in RR-TB case detection through upfront Xpert testing.” Awan et al. 2018, pg. 902.
- 3
See Zero TB’s website.
- 4
- “The treatment cascade begins when a person is evaluated for TB disease. This evaluation may include several different procedures, such as laboratory tests, clinical evaluation, and chest X-ray. The evaluation process may be very fast (e.g. if a person immediately has a positive laboratory test result), or may last a couple of weeks (e.g. if the person initially has a negative sputum test and is sent home with 2 weeks of antibiotics to rule out pneumonia). At the end of this process, a person should get a diagnosis: either they have TB disease or they do not have TB disease. Those diagnosed with TB disease should immediately start appropriate TB treatment.” Zero TB Initiative, A best-practice framework of program indicators for monitoring a comprehensive approach to the tuberculosis epidemic, 2017, pg. 20.
- IRD’s Zero TB staff told us that it uses mobile X-ray screening vans as part of its initial case-finding process.
- “The first part of the prevention cascade involves identifying people in target populations at high risk for developing TB, who should be given preventive therapy. Examples of common target populations for preventive therapy include contacts of TB patients, people living with HIV, and healthcare workers.” Zero TB Initiative, A best-practice framework of program indicators for monitoring a comprehensive approach to the tuberculosis epidemic, 2017, pg. 31.
- 5
Dr. Aamir Khan, Executive Director, IRD, conversation with GiveWell, November 1, 2021 (unpublished).
- 6
Dr. Aamir Khan, Executive Director, IRD, conversation with GiveWell, November 1, 2021 (unpublished).