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Fidelis

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Funded by the Canadian International Development Agency (CIDA), FIDELIS –the Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB– is a case-finding initiative to rapidly assess and implement innovative local tuberculosis control activities designed to find and cure new smear-positive patients.
Since its inception in 2003, 51 FIDELIS projects have been implemented in 18 countries have been approved for funding (as of July 2008). Approximately 70% of the projects are in the world’s 10 highest-burden** countries for tuberculosis. Project activities range from the introduction of DOTS* services in army, police, and prison health services in Sudan, to mobilising 2.3 million primary and secondary school students in China to detect possible tuberculosis cases in their families.

‘We believe that solutions to delivering TB treatment in poor and remote areas can best be found locally,’ says Prof Donald A Enarson, initial Union coordinator. ‘FIDELIS offers the funds to local groups while The Union provides the technical and management support to help them implement their solutions. FIDELIS may serve as a model to discover what best practices can be used to address other urgent global public health problems at the local level.

’ FIDELIS aims to address populations with limited access to modern TB treatment. ‘The FIDELIS programme is an initiative that specifically targets populations with limited access to health services,’ highlighted Dr. I. D. Rusen, Director of the Tuberculosis Control and Prevention Department of The Union. ‘Many of our projects involve people and communities leading the fight against TB. In Bangladesh, for example, one project provided additional education and training to cured TB patients so that they would be better equipped to detect new TB cases within the community. Another project in Pakistan has hosted radio calls in a talk-show with cured TB patients answering calls from the community to explain how they were diagnosed and then treated’.
In China alone, FIDELIS projects covered  415 million people in 700 counties. In addition, FIDELIS projects have helped train more than 130,000 Chinese health workers.
Since April 2003, the FIDELIS initiative has received approximately C$32 million from the Canadian government. Each project contract is for a 12-month period, with budgets ranging from US $150,000–$250,000. If a project is successful – able to achieve an additional weighted treatment success for less than $80 per case – it becomes eligible for further funding.

As if July 1, 2008, the 51 phase I projects had detected a total of 272,216 new smear positive cases – an increase of 85,185 cases compared to the same settings in the previous year. Ongoing quantitative and qualitative analysis will further explore the effectiveness of various case-finding approaches.

*DOTS: Directly Observed Treatment Short Course ** the high burden TB countries are, by number of cases: India, China, Indonesia, Nigeria, Bangladesh, Pakistan, South Africa, Ethiopia, The Philippines , Kenya, Democratic Republic of Congo, Russian Federation, Viet Nam, United Republic of Tanzania, Brazil, Uganda, Thailand, Mozambique, Myanmar, Zimbabwe, Cambodia, Afghanistan

 
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