GiveWell aims to find the best giving opportunities we can and recommend them to donors (why we recommend so few charities). We tend to put a lot of investigation into the organizations we find most promising, and de-prioritize others based on limited information. When we decide not to prioritize an organization, we try to create a brief writeup of our thoughts on that charity because we want to be as transparent as possible about our reasoning. The following write-up should be viewed in this context: it explains why we determined that (for the time being), we won't be prioritizing the organization in question as a potential top charity. This write-up should not be taken as a "negative rating" of the charity. Rather, it is our attempt to be as clear as possible about the process by which we came to our top recommendations. We prioritized analysis of TB REACH (http://www.stoptb.org/global/awards/tbreach/, archived) because it works on tuberculosis control, a program area we find promising. After some initial research, as of August 2012, we have deprioritized further work on TB REACH, though we hope to return to it in the future.
Published: September 2012
What do they do?TB REACH is an initiative of the Stop TB Partnership. It reviews proposals and provides funding for projects aiming to detect cases of TB that would not otherwise be registered with national TB programs.1 It was launched in 2010 with grant of 120 million Canadian dollars (about 115 million USD) from the Canadian International Development Agency (CIDA).2 In its first two waves of funding, it provided 75 grants, totaling 50 million USD.3 Projects focus on one or more of the following areas:4
- Testing those who have come in contact with an identified TB patient for TB ("contact investigation")
- Actively seeking out and testing populations at high risk of TB, including migratory populations, prisoners, and HIV patients
- Purchasing new diagnostic equipment and supplies, including the Xpert MTB/RIF
- Public education and mobilization to encourage individuals to seek out TB testing and high quality TB care
Our processWe spoke several times with representatives from TB REACH and reviewed documents they sent us. After this analysis, we believe that TB REACH may be successfully identifying additional TB cases and causing these individuals to be treated in higher quality TB control programs. Were TB REACH to accomplish this, it would likely be reducing mortality and morbidity from TB as well as slowing the spread of multi-drug-resistant TB (MDR-TB).
Reasons for deprioritizationWe have not yet been able to arrive at an estimate of the number of lives saved, the amount of morbidity prevented, or the degree to which these actions would slow the spread of MDR-TB. Based on our conversations with TB REACH representatives, we believe it would be quite difficult and time consuming to do so. We know relatively little about the how much better the TB care is that patients receive once they are registered with national TB control programs than the care that they would have received otherwise. We also know relatively little about the humanitarian implications of these differences (i.e., the extent to which they might save lives, slow the spread of MDR-TB, etc.) For the time being, we are prioritizing interventions that we can confidently and efficiently identify as cost-effective ways to improve lives. In addition, a full analysis of TB REACH would require us to assess many monitoring and evaluation reports from its funded projects to determine whether we believe there is compelling evidence that TB REACH has identified additional cases of TB. We have reviewed several of these reports, and do not believe that they, in and of themselves, make a compelling case for impact. We would need to review many more of them to reach a conclusion in which we were confident.
Possible future analysisWe hope to revisit TB REACH in the future. When we do so, we will attempt to:
- Arrive at reliable estimates for the mortality/morbidity prevented by TB REACH's projects and the impact of the projects on the spread of MDR-TB
- Speak with people with relevant knowledge about TB control to better understand all possible priorities for TB control and where TB REACH fits in.
- Cohen, Ted, and Megan Murray. 2004. Modeling epidemics of multidrug-resistant M. tuberculosis of heterogeneous fitness (PDF). Nat Med 10(10): 1117-1121.
- Dye, Christoper, and Marcos Espinal. 2001. Will tuberculosis become resistant to all antibiotics? (PDF). Proc. R. Soc. Lond. B 268: 45-52.
- Khan, Aamir J., et al. 2012. Engaging the private sector to increase tuberculosis case detection: An impact evaluation study. The Lancet. DOI:10.1016/S1473- 3099(12)70116-0.
- Sahu, Suvanand. TB REACH Team Leader. Phone conversation with GiveWell, November 11, 2011.
- Sahu, Suvanand, and Jacob Creswell. TB REACH Team Leader and Technical Officer. Phone conversation with GiveWell (DOC), March 5, 2012.
- Sahu, Suvanand, and Jacob Creswell. TB REACH Team Leader and Technical Officer. Phone conversation with GiveWell, May 2, 2012.
- Stop TB Partnership. About TB REACH. http://www.stoptb.org/global/awards/tbreach/about.asp (accessed June 12, 2012). Archived by WebCite® at http://www.webcitation.org/68NV9zbQN.
- TB REACH. Factsheet (PDF).
- TB REACH. Interventions. http://www.stoptb.org/global/awards/tbreach/interactive/pages/interventions00.html (accessed June 12, 2012). Archived by WebCite® at http://www.webcitation.org/68NVYwitB.
- Tiemersma, Edine, et al. 2011. Natural history of tuberculosis: Duratio
- 1. "TB REACH awards grants up to US $1,000,000 for a one year period to selected institutions or organizations that have put forward successful proposals in a timely fashion in order to detect additional TB cases." Stop TB Partnership, "About TB REACH."
- 2. TB REACH was launched in 2010 and will run until 2016, thanks to a CAD$ 120 million grant from the Canadian International Development Agency." TB REACH, "Factsheet," Pg 1.
- 3. "TB REACH has committed nearly $50 million to 75 projects in 36 countries covering a wide range of interventions." TB REACH, "Factsheet," Pg 1.
- 4. TB REACH, "Interventions."
- 5. Suvanand Sahu, email to GiveWell, September 7, 2012.
- 6. "Our approach to evaluation is very simple. We look at the case detection numbers in the evaluation population before and after the project. When there is a control population, we look at that as a comparison to the evaluation population." Suvanand Sahu and Jacob Creswell, phone conversation with GiveWell, March 5, 2012.
- 7. Suvanand Sahu, email to GiveWell, September 7, 2012.