Designup

Category: Europe & Eurasia

  • Conference paper: The Study of Barriers and Facilitators to Adherence to Treatment among Drug Resistant Tuberculosis Patients in Georgia to Inform Policy Decision

    The abstract has been submitted and accept for oral presentation at The Union 2017 – 48th Union World Conference on Lung Health, 11 – 14 October, 2017 Guadalajara, Mexico

    The study outlines different health system factors as long as some social and economic elements influencing the adherence behavior to TB treatment among MDR-TB patients in Georgia. The study concludes that factors are closely interlinked and self-reinforcing.

    The study provides evidence that may help policy-makers develop effective strategies for improving treatment outcomes among DR-TB patients. The study findings might be helpful for other countries in the region where TB burden is also high.

    The study report and policy brief can be found here.

    Download the abstract here.

  • Article: Human immunodeficiency virus prevalence and risk determinants among people who inject drugs in the Republic of Georgia

    [vc_row][vc_column][vc_column_text]A new paper discusses HIV prevalence and risk factors among people who inject drugs in Georgia. The article was just published in The Journal of Infection in the Developimg Countries and is authored by Natia Shengelia, Ivdity Chikovani and Lela Sulaberidze.

    In Georgia as in most Eastern European countries, injecting drug use still remains one of the leading transmission modes of HIV infection. A cross -sectional, anonymous bio-behavioral survey of PWID was conducted in seven cities of Georgia in 2014-2015. Overall 2,022 PWID were investigated. Bivariate and multivariate regression analyses were performed to identify association of HIV positivity with other factors.

    Significant associations were found between HIV positivity and history of drug injection, older age at first drug injection, safe sex behavior last year and preventive program coverage. HIV prevalence among PWID is stable and remains at low level. Our study shows that preventive interventions influence the sexual behavior of HIV positive PWID, however, the majority of injecting drug users are still not reached with these interventions. A changing environment may present additional challenges for harm reduction and current safe practices may change unless continuously supported by innovative HIV prevention programming.

    Download the full paper here.

    The article is also available on ResearchGate platform.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][ultimate_spacer height=”30″][/vc_column][/vc_row]

  • Conference paper about realist evaluation: Informing policy, assessing its effects and understanding how it works for improved Tuberculosis management in Georgia

    In the last week of October, 2017 Brisbane, Australia hosted International Conference for Realist Research Evaluation and Synthesis – Realist2017. Realist evaluation is complex sensitive approach and is useful for decision makers because rather responding the question “does the intervention or program work” Realist Evaluation indicates “What works for whom in what circumstances, and how?”

    Curatio International Foundation and the partner institution – Institute of Tropical Medicine, from Antwerp, Belgium presented a work undertaken in the frame of #Results4TB project. During the session professor Bruno Marchal, Ariadna Nebot and Lela Sulaberidze discussed issues around Informing policy, assessing its effects and understanding how it works – Combining realist evaluation, cost analysis and impact assessment of a policy for better TB care in Georgia.

    During the session, the conference audience was informed about the new project – provider Results-Based Financing for improved TB care management in Georgia that is currently being designed to be piloted from 2018 in the country. In this project, we use Realist Evaluation approach to evaluate mechanisms of effect and impact of the intervention. At the conference research team introduced insights of using Realist Evaluation to not only elicit the Programme Theory of the policy-makers and implementers, but also of the researchers, to help

    • Policymakers to achieve a better view on the problem and the solution, and the conditions required to make it work
    • Researchers to develop a better common understanding that would lead to a better research design, and an integrated data collection and analysis strategy
    • Review of the existing evidence is supposed to contribute to better-informed policies and evaluations

    During the presentation research team emphasized the following issues: 1. Insights into the program theory elicitation process, from concept to practice; 2. Participative methods applied during the program theory elicitation.

     Please read the slightly modified presentation.

  • Network Coordination Partner: The Learning Network for Countries in Transition

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    Introduction and Overview

    According to a new Gavi strategy for 2016-­2020 one of the strategic goals for Gavi is to assure that EPI programs are sustainable in a long-term, especially within the group of countries transitioning out of Gavi financial support during the next five-­year period. A large number of countries receiving support from Gavi, are transitioning or expected to transition out of support in the next few years.[/vc_column_text][/vc_column][vc_column width=”1/2″][vc_column_text]

    Visit the project website 

    [/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][vc_column_text]As transition is a new challenge middle-­income countries are faced, it is crucial to capture experiences of countries go through the transition process and utilize country-­to-­country peer learning to address common challenges in immunization financing and programming. For this purposes a new initiative, the Learning Network for Countries in Transition was launched in May 2017. Results for Development (R4D) is leading network coordination and technical facilitation, drawing on partners and experts as needed.

    Specific objectives of the project are following:

    1. Facilitate knowledge exchange on technical topics;
    2. Build community and sustain the collaborative process;
    3. Co-develop clear and agreed output(s) related to priority technical topics;
    4. Support LNCT country core groups;
    5. Help with broader dissemination of LNCT messages, approaches, and lessons.
    Organizations Involved in the Research

    Project is implemented by Results for Development Institute, Inc. “R4D” in partnership with Learning Network for Countries in Transition, middle-income countries in transition from GAVI support.

    The project is funded by Bill&Melinda Gates Foundation.

    Expected Results

    CIF will support R4D in conducting scoping literature review and interviews with partner organizations and country stakeholders to a) better understand current country processes, b) identify other country experiences regionally/ globally that would provide good learning opportunities; c) explore existing approaches, tools, and resources on identified technical topics; d) refine identified topics through understanding of country demand, experiences, and gaps in knowledge.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][/vc_column][/vc_row]

  • Technical Assistance to Evaluate HIV Monitoring and Evaluation System in the Republic of Moldova

    Introduction and Overview

    The evaluation is expected to comprehensively assess the HIV Monitoring and Evaluation (M&E) system aimed to standardizing the reporting forms, build the national information flow within HIV related organizations, developing the national M&E System and Plan. The evaluation has to provide recommendations for improvement of M&E System, enhance its quality and comprehensiveness, including coordination and sustainability of the system.

    The evaluation will assess the HIV/AIDS M&E system, type of indicators and data flows starting from the first service contact level up to the national level, between different sectors and with particular emphasis on Prednestrovya region. The evaluation will last by the end of November, 2017.

    Organizations involved in the research

    Public Institution “Coordination, Implementation and Monitoring Unit of the  Health  System Projects” is implementing the project, funded by The Global Fund. Partners of the project are Ministry of Health (MoH) and other sectorail ministries under the leadership of the National Coordination Council of Moldova.

    The HIV Monitoring and Evaluation is one part of the project fulfilled by Curatio International Foundation.

    Expected Results

    The Program Management structure, regional health authorities, health and other service providers will largely benefit from enhanced and comprehensive M&E system, for which the evaluation will formulate recommendations.

  • Georgian Solution for a Post-Soviet TB Program: Can Integration into Primary Health Care Improve TB Care?

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    By Julia Makayova

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    Former Soviet countries in the Eastern European and Central Asian (EECA) region are fighting the prevailing perception that their outdated hospital-based tuberculosis (TB) programs are failing to provide patient-centered care. Since 2005, Georgia has emerged as the regional leader in decentralizing TB services and implementing country-wide directly-observed treatment (DOTS) coverage in line with the major components of the international Stop TB strategy.

    Through several waves of healthcare reforms, former stand-alone TB dispensaries across the country,  except the major cities, have become physically integrated into Primary Health Care (PHC) centers which are now owned by private providers who contract TB doctors (in Georgia—only phtysiatrists) and DOT nurses to deliver TB services as part of the TB state program. Universal access to diagnostic and treatment services is ensured and facilitated by demand-side incentives and robust monitoring and evaluation practices which are reflected in high 83% treatment success rate for all new and ralapse cases registered in 2014.

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    Photo credit: Sophio Gokhelashvili

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    However, the most challenging drug-resistant TB (DR-TB) remains Georgia’s Achilles heel, as no more than 43% of patients completed treatment successfully in 2013, and every third of them interrupted treatment in the past three years.

    [/vc_column_text][vc_column_text]The latest TB adherence report in Georgia found that almost half of drug-resistant patients are lost to follow-up already by the 8th month of treatment. This figure is not surprising if we put ourselves in the shoes of patients who have to travel to TB units six days a week for at least 18 months (DOTS units are not within walking distance for most patients, and flexible programs like Video-Observed Treatment (VOT) have limited coverage under pilot schemes). Poor management of side effects from anti-TB drugs also contributes to dropouts. Ironically, hospitalized patients in the Tbilisi TB center are better off as they have access to medical specialists who manage their adverse reactions. In rural areas, patients do not always use general healthcare services, required to complement their TB treatment. Despite structural integration of TB services into primary care facilities, the vertical TB program is not linked with the PHC services. As a result, TB patients are not well informed about certain free general care services under the UHC program, and they avoid additional expenses associated with seeking specialists on their own. Grossly underpaid, TB doctors are discouraged to meticulously engage in holistic patient care which are required to support drug-resistant patients. Budding medical students see no appealing career path in phthisiatry either, so the numbers of TB specialists are declining. The shortage is already felt in some regions where only one TB doctor serves several districts. Lack of coordination between the TB program and primary care services exacerbates sub-optimal organization of TB services. While a TB doctor, family doctor and other specialists often occupy the same facility, they do not share patient records and rarely cross-manage co-morbidities. As a result, formal decentralization of TB services in rural and semi-urban areas falls short of providing country-wide patient-centered care: if you want to receive quality treatment, better go to the Tbilisi TB center. Although the government is committed to addressing these shortcomings,[/vc_column_text][vc_column_text]

    it is unclear whether a vertical program can cope with these challenges, even with further investments.

    [/vc_column_text][vc_column_text]Drug-resistant patients require a flexible chronic care model which is more appropriate for the primary care level. Moreover, the declining TB epidemic will eventually  phtysiatry redundant and the costly TB center unsustainable. This raises the question: how to uphold the benefits of holistic care offered at the primary care level without losing the capacity of a strong infection control vertical program? How much responsibility for TB care can family doctors successfully assume? Georgia has decided to test the feasibility of integrating TB services into primary care. Currently, I am here studying how such model could work.

    I conducted a literature review on TB case management at the primary health care (PHC) level and found that[/vc_column_text][vc_column_text]

    integration of specialized TB services into general practice is now understood to be essential to patient-centered care.

    [/vc_column_text][vc_column_text]Conceptually, PHC centers which are operated by a family doctor or general practitioner can be ideal sites for participating in TB control as they are geographically close to patients, can deal with a broad range of health conditions, and ensure confidentiality which is crucial for stigmatized TB patients. However, it does not mean that all family doctors are expected to fully treat TB and assume all responsibilities of TB specialists. A quite successful model of TB care features multidisciplinary team case-manegement, practiced in countries like Norway, UK, and the US, which have 50% fewer patients lost to follow up, than Georgia (data on Norway, UK, USA). Particularly designed to support patients with more complex needs, multidisciplinary teams include a mix of prefossionals such as a TB lead physician (general practitioner), case manager, infectious disesase doctor or other TB specialist, as well as a social worker, peer supporter, psychiatrist, and legal services representative. However, all countries have different history of TB epidemic and TB care management, making it impossible to simply adopt more successful models. Reforming vertical TB programs is still new, so countries learn by trial and error. Several countries in the EECA region started engaging family doctors in TB control beyond case identification and diagnostic referral, enabling them to provide DOTS in Uzbekistan, Romania and Moldova, and even allowing family doctors in Serbia to prescribe anti-TB drugs. Unfortunately, there is little documented evidence from international practices in shifting TB service provision from specialized care to general practice. Country reports and project evaluations usually discuss normative dimenstions of interventions, and document specific inputs and outcomes, but rarely go in depth on the rationale behind certain programmatic choices and on-going operational challenges.[/vc_column_text][vc_column_text]

    We need more present-day evidence that fills the gaps of publication delays to inform policy decisions promptly.

    [/vc_column_text][vc_column_text]In March, Georgia launched a 48-month Results-Based Financing (RBF) scheme for tuberculosis care, hoping to incentivize family doctors and TB specialists (phtysiatrists and DOT nurses) to collaborate in patient-centered TB management. It is expected that giving family doctors more responsibility for TB case management would bring health services closer to patients. Engagement of family doctors would also stimulate the creation of linkages between TB doctors and other health specialists, ensuring that patients receive quality health services along the continuum of care. This program is currently in the design stage. Selective RBF schemes for TB have been introduced in Kazakhstan and Moldova, and pilots are underway in Armenia and Romania. Little impact evidence is documented in this area as well, and I hope the blog will encourage more timely and informal international knowledge exchange.

    What we understand so far is that countries have to deal with a number of health system and individual barriers related to health financing, medical beliefs and attitudes, as well as communication and leadership skills of healthcare managers at all levels of care. Several studies consistently note that proper coordination of TB case management activities did not happen when family doctors and TB specialists were assigned new roles without ensuring that they understand and accept them. Other studies warn us not to underestimate the importance of healthcare managers whose leadership and motivation are as crucial as the competency of medical specialists. Moreover,[/vc_column_text][vc_column_text]

    designing a flawless intervention from a system’s perspective will not ensure acceptability and uptake of the innovation by health professionals and patients.

    [/vc_column_text][vc_column_text]Studies in Brazil, Turkey and India note that health workers’ resistance to changing professional practice was one of the major impediments to smooth TB integration in general practice. Hierarchical professional relationships among medical specialists are common in vertical programs such as here in Georgia. To establish successful case management of TB in primary care, healthcare managers are faced with the challenging task of ensuring that family doctors do not feel dominated and undervalued by TB specialists and, on the other hand, they do not underestimate their capacity to take new responsibilities and make a positive change for TB patients. The bottom line question is:[/vc_column_text][vc_column_text]

    HOW to ensure harmonious task shifting when it requires not only acquisition of new skills and competencies but ultimately a paradigm shift for healthcare workers and patients?

    [/vc_column_text][vc_column_text]Lessons from other countries suggest that functional information sharing systems and strong linkages between healthcare professionals at all levels of care become crucial to successful integration. Delayed or incomplete patient records disempower healthcare providers as they experience inefficiency of the system, caused by duplication of activities and endless paperwork. But again, HOW to establish these linkages? What crucial inputs should not be overlooked, especially once financial and regulatory mechanisms are aligned with the intended model of care? How to establish clear guidelines for the members of TB care team, while accommodating individual patient needs and variations in health resources across the country? How to ensure personal accountability while rewarding team performance?

    Even though a lot of unanswered questions remain, the momentum for sustainable transformation is there, giving us an excellent opportunity to exchange the newest evidence and accelerate global progress towards TB eradication. As we will be following how Georgia deals with these challenges, we encourage you to share with us your experiences integrating TB services in the primary care, including innovative solutions and treatment models that promote patient-centered care.

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  • Results4TB: Designing and evaluating provider Results Based Financing for Tuberculosis in Georgia

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    Introduction and Overview

    Curatio International Foundation in partnership with Queen Margaret University (UK), London School of Hygiene and Tropical Medicine (UK) and Antwerp Institute of Tropical Medicine (Belgium) is implementing a study “Designing and evaluating provider results-based financing for tuberculosis care in Georgia: understanding costs, mechanisms of effect and impact”.[/vc_column_text][/vc_column][vc_column width=”1/2″][vc_column_text]

    Visit the project website

    [/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][vc_column_text]The 48-month duration research project will assist the Government of Georgia in developing a provider incentive payment scheme for Tuberculosis (as a pilot intervention) and will generate evidence on its effects on adherence and treatment success rates and costs.

    The research will seek to answer the following research questions:

    (1) What is the impact of provider-focused Results-Based Financing (RBF) on patients’ adherence to tuberculosis treatment and treatment outcomes of both Drug-Susceptible (DS) and Multi Drug Resistant (MDR) patients in Georgia?

    (2) Is the RBF intervention cost-effective?

    (3) How does it work, for whom and in which conditions? and

    (4) How should RBF be modified to optimize national roll-out for this and possibly other health services?

    Project has launched in March 2017 and will run till March 2021[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][ultimate_spacer height=”30″][vc_column_text]

    Organizations involved in the research

    The project is funded through the Joint Health Systems Research Initiative which is jointly funded by the Department of International Development (DFID), the Economic and Social Research Council (ESRC), the Medical Research Council (MRC) and the Wellcome Trust (WT).

    The study will be implemented by CIF (Georgia), Queen Margaret University (UK), London School of Hygiene and Tropical Medicine (UK) and Antwerp Institute of Tropical Medicine (Belgium).

     

    Expected Results and Their Application

    The beneficiaries of this research will be TB patients, nurses and physicians involved in TB care, health facility managers, policy-makers, community members and the scientific community in Georgia, in the region and globally.

    The research will narrow the knowledge gap existing around RBF interventions, such as their application in public/private settings and their cost-effectiveness, the conditions of success and the wider (negative and positive) consequences of the scheme.

    The research will also produce methodological innovation regarding the use of realist evaluation alongside cost-effectiveness analysis.

    The evidence produced through this research will be used by national policy-makers to reform the financing of primary health schemes in a way that improves efficiency, quality, and sustainability of services. Additionally, findings will be beneficial for other LMICs, particularly for those with a similar vertical organization of TB services (most of the former Socialist countries of Eastern and Central Europe and Central Asia) and for countries where private providers play an important role in the provision of TB services

     

    Would you like to be updated about the project achievements?

    The Results4tb project has its own website. Visit the page to learn more about the project.[/vc_column_text][/vc_column][/vc_row]

  • Article: Determinants analysis of outpatient service utilization in Georgia: can the approach help inform benefit package design?

    Curatio International Foundation conducted secondary data analyses of Health Service Utilization and Expenditure survey (2 waves), conducted by Ministry of Labor Health and Social Affairs of Georgia, supported by WHO and The World Bank.

    We studied factors that impact utilization of outpatient health services in Georgia. Several important findings have been revealed, that can be successfully used to update existing outpatient service package and make it more relevant to the needs of Georgian population.

    1. Household income is linked to service consumption – Families with high and middle income are more likely to use outpatient services than those who have low income;
    2. Out of the pocket payment is one of the important barriers for service usage, in particular increase of service costs by one Georgian Lari reduces the use of outpatient services by 2%;
    3. Patients with chronic illness are less likely to use outpatient services, compared to patients with acute health problems – frequency of outpatient service utilization is 2 times less;
    4. Utilization of outpatient services is affected by the age factor – people from 45 to 64 are less likely to use outpatient services and often seek self-treatment.

    To respond to the above listed challenges, it is important to fit outpatient service packages to the population needs.

    The recent changes in the Universal Health Care Program, initiated by Georgian government and launched in May, 2017 will be a step forward to improve population financial protection. The changes respond to the research findings and recommendations in regard of outpatient services, that are fully represented in the article.

    [vc_button url=”http://curatiofoundation.org/wp-content/uploads/2017/05/12961_2017_Article_197.pdf” text=”Download full article” size=”” align=”left” type=”primary” outlined=”0″ icon=”” target=”_blank”]

     

  • Designing and evaluating provider results-based financing for tuberculosis care in Georgia (RBF4TB)

    Introduction and Overview

    CIF in partnership with Queen Margaret University (UK), London School of Hygiene and Tropical Medicine (UK) and Antwerp Institute of Tropical Medicine (Belgium) is implementing a study “Designing and evaluating provider results-based financing for tuberculosis care in Georgia: understanding costs, mechanisms of effect and impact”. The 48-month research project will assist the Government of Georgia in developing a provider incentive payment scheme for Tuberculosis. It will generate evidence on its effects on adherence and treatment success rates and costs.

    The research will seek to answer the following research questions:

    (1) What is the impact of provider-focused Results-Based Financing (RBF) on patients, adherence to tuberculosis treatment and treatment outcomes of both Drug-Susceptible (DS) and Multi Drug Resistant (MDR) patients in Georgia?

    (2) Is the RBF intervention cost-effective?

    (3) How does it work, for whom and in which conditions?

    (4) How should RBF be modified to optimize national roll-out for this and possibly other health services?

    Project has launched in March 2017 and will run till March 2021.

    Organizations involved in the research

    The project is funded through the Joint Health Systems Research Initiative, which is jointly funded by the Department of International Development (DFID), the Economic and Social Research Council (ESRC), the Medical Research Council (MRC) and the Wellcome Trust (WT).

    The study will be implemented by CIF (Georgia), Queen Margaret University (UK), London School of Hygiene and Tropical Medicine (UK) and Antwerp Institute of Tropical Medicine (Belgium).

    Expected Results and Their Application

    The beneficiaries of this research will be TB patients, nurses and physicians involved in TB care, health facility managers, policy-makers, community members and the scientific community in Georgia, in the region and globally.

    The research will narrow the knowledge gap existing around RBF interventions, such as their application in public/private settings and their cost-effectiveness, the conditions of success and the wider (negative and positive) consequences of the scheme.

    The research will also produce methodological innovation regarding the use of realist evaluation alongside cost effectiveness analysis.

    National policy-makers will use the evidence produced through this research to reform the financing of primary health schemes in a way that improves efficiency, quality and sustainability of services. Additionally, findings will be beneficial for other LMICs, particularly for those with a similar vertical organization of TB services (most of the former Socialist countries of Eastern and Central Europe and Central Asia) and for countries where private providers play an important role in the provision of TB services.

     

  • Barriers and Facilitators to Adherence to Treatment Among Drug Resistant TB Patients in Georgia

    [vc_row][vc_column][vc_column_text]Tuberculosis is a global challenge to public health throughout the world. Poor adherence to treatment remains a significant problem that prevents countries from obtaining high treatment success rates that is essential for health systems to control the epidemic and decrease spread of the disease.

    In 2016 Curatio International Foundation conducted a qualitative study to investigate factors that enhance or hinder treatment adherence among Drug Resistant TB patients (DR-TB) in Georgia. The study revealed different types of factors affecting treatment adherence among DR-TB patients and grouped them into structural, social, personal and health system factors according to the study conceptual framework. The study made it clear that all factors are closely interlinked and mutually influence each other.

    The study provides evidence that may help policy-makers develop effective strategies for improving treatment outcomes among DR-TB patients. The study findings might be helpful for other countries in the region where TB burden is also high.

    The study report and policy brief is downloadable below:[/vc_column_text][vc_empty_space][/vc_column][/vc_row][vc_row parallax_image=”” columns_type=”default” section=”” full_screen=”” vertical_centering=”” full_width=”” full_height=”” background=”” bg_color_info=”” img=”” parallax=”” parallax_bg_width=”110″ parallax_reverse=”” video=”” bg_type=”” parallax_style=”” bg_image_new=”” layer_image=”” bg_image_repeat=”” bg_image_size=”” bg_cstm_size=”” bg_img_attach=”” parallax_sense=”” bg_image_posiiton=”” animation_direction=”” animation_repeat=”” video_url=”” video_url_2=”” u_video_url=”” video_opts=”” video_poster=”” u_start_time=”” u_stop_time=”” viewport_vdo=”” enable_controls=”” bg_override=”” disable_on_mobile_img_parallax=”” parallax_content=”” parallax_content_sense=”” fadeout_row=”” fadeout_start_effect=”” enable_overlay=”” overlay_color=”” overlay_pattern=”” overlay_pattern_opacity=”” overlay_pattern_size=”” overlay_pattern_attachment=”” multi_color_overlay=”” multi_color_overlay_opacity=”” seperator_enable=”” seperator_type=”” seperator_position=”” seperator_shape_size=”” seperator_svg_height=”” seperator_shape_background=”” seperator_shape_border=”” seperator_shape_border_color=”” seperator_shape_border_width=”” icon_type=”” icon=”” icon_size=”” icon_color=”” icon_style=”” icon_color_bg=”” icon_border_style=”” icon_color_border=”” icon_border_size=”” icon_border_radius=”” icon_border_spacing=”” icon_img=”” img_width=”” ult_hide_row=”” ult_hide_row_large_screen=”” ult_hide_row_desktop=”” ult_hide_row_tablet=”” ult_hide_row_tablet_small=”” ult_hide_row_mobile=”” ult_hide_row_mobile_large=””][vc_column text_color=”” animate=”” animate_delay=”” width=”1/2″][vc_column_text]

    Barriers and Facilitators to Adherence to Tuberculosis Treatment Among Drug Resistant TB Patients in Georgi… by CuratioCIF on Scribd

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    Factors Associated Adherence to TB Treatment in Georgia_Report_Eng by CuratioCIF on Scribd

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