title: Associations between national tuberculosis program budgets and tuberculosis outcomes: an ecological study.
abstract: BACKGROUND
  The objective of this study is to explore the associations between national tuberculosis program (NTP) budget allocation and tuberculosis related outcomes in the World Health Organization's 22 high burden countries from 2007-2009.
  
  
  METHODS
  This ecological study used mixed effects and generalized estimating equation models to identify independent associations between NTP budget allocations and various tuberculosis related outcomes. Models were adjusted for a number of independent variables previously noted to be associated with tuberculosis incidence.
  
  
  RESULTS
  Increasing the percent of the NTP budget for advocacy, communication and social mobilization was associated with an increase in the case detection rate. Increasing TB-HIV funding was associated with an increase in HIV testing among TB patients. Increasing the percent of the population covered by the Directly Observed Therapy (DOT) program was associated with an increase in drug susceptibility testing. Laboratory funding was positively associated with tuberculosis notification. Increasing the budgets for first line drugs, management and multi-drug resistant tuberculosis (MDR-TB) was associated with a decrease in smear positive deaths.
  
  
  CONCLUSIONS
  Effective TB control is a complex and multifaceted challenge. This study revealed a number of budget allocation related factors associated with improved TB outcome parameters. If confirmed with future longitudinal studies, these findings could help guide NTP managers with allocation decisions.
authors.affiliation: Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Manoa, HI, USA.
authors.forename: Will
authors.initials: W
authors.lastname: Chapple
authors.forename: Alan Roy
authors.initials: AR
authors.lastname: Katz
authors.forename: Dongmei
authors.initials: D
authors.lastname: Li
mesh_terms: D000995:Antitubercular Agents / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D002017:Budgets; D023801:Directly Observed Therapy / Q000191:economics / Q000379:methods*; D015658:HIV Infections / Q000175:diagnosis; D006801:Humans; D008826:Microbial Sensitivity Tests; D008962:Models, Theoretical; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000191:economics / Q000209:etiology; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents