IRD Global — Bridge Grant for Tuberculosis Program (November 2021 and April 2022)


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

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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.


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.


Document Source
Awan et al. 2018 Source
Shrestha et al. 2021 Source (archive)
Zero TB Initiative, A best-practice framework of program indicators for monitoring a comprehensive approach to the tuberculosis epidemic, 2017 Source (archive)
  • 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

  • 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).