Phase One: Online Search
Beginning in June of 2015, an in-depth online desk review was used to find relevant projects and key stakeholders working in the drug supply and access space. Researchers combed through the reports, web-based materials, and other strategy documents from key institutions to identify areas of overlap with this mapping initiative. Researchers collected relevant information that would inform a later interview with each project contact. From this preliminary research, 60 projects were identified.
Phase Two: Survey and Interview
Researchers created a standardized Qualtrics survey tool which was sent to project contacts to gather more specific information about the identified activities This Qualtrics survey was used to gather more in-depth information specific to each project. Information sought through the survey included project and contact name, organizations affiliated with the project in question, locations where the project was active, beginning and end dates of project, summary of project actions, market indicators addressed by the project, and a brief overview of the project and stakeholder.
Following the surveys, researchers followed up with the project contacts for a telephone interview. From September of 2015 to March of 2016, 26 project contacts responded to the Qualtrics survey, and 21 interviews were conducted over phone or Skype. Telephone interviews were tailored using information gathered from relevant reports and websites as well as from the Qualtrics survey responses. Prior to the interviews, project contacts were sent a list of the questions to expect during the interview. At least two researchers were present for each interview, with one leading the interview and the other transcribing the conversation. During these interviews, researchers asked the project contacts to expand on information provided in the Qualtrics survey to ensure a comprehensive understanding of activities was gathered. Researchers also asked project contacts if they were aware of other initiatives addressing supply and access to MDR-TB drugs. A master spreadsheet was kept to record date of interview, who was interviewed, and when a follow up was needed.
Phase Three: Data Verification
Following the interview, all data compiled from desk research, Qualtrics surveys, and telephone interviews was summarized and sent to the lead project contact for their review and approval. Researchers requested that the project contacts correct any errors and make all necessary revisions to the information provided. These revisions were incorporated into the finalized project summary, which was sent back to the project contact for final approval. For projects that were unable to be contacted, additional web research was conducted to reflect any updates in programmatic activities or in available project contacts.
Phase Four: Data Entry and Review
All data collected from desk research and interviews and approved by the project contacts was compiled into an online database where researchers performed both qualitative and quantitative analysis on the MDR TB drug landscape. Data was checked for omissions, duplicates, and errors by each of the researchers based on information provided by project contacts if an interview or survey was completed, or based on information collected through the desk research if no contact was available or responded. Of the 60 projects identified, 15 interviewed projects were in scope, and 40 total were ruled to be in scope of this project by addressing at least one of the seven market indicators and being active between 2014 and 2020.
A narrative analysis of this data was written and shared with a group of experts in July of 2016. These experts represented organizations with key information in the MDR-TB landscape. This stakeholder meeting discussed the identified gaps and opportunities related to MDR-TB drug supply and access. Those in attendance also recommended methods for sharing these findings via planned stakeholder meetings and a web-based mapping tool.
The analysis of the work to address MDR-TB drug accessibility plus recommendations for policy based on this analysis may be viewed here.
Mapping Tool Development
From June to December of 2016, researchers collaborated with web developers to create a mapping tool to visualize the data collected in the first round of research. Additional tuberculosis data for countries and WHO regions was sourced from the WHO Global Tuberculosis Report 2015 and 2016, as well as from the WHO Country Profiles. This presentation was intended to make its cross-cutting analysis as accessible as possible, such that stakeholders may identify need, gaps, overlaps, and opportunities in the MDR TB pharmaceutical landscape, as well as collaborate with other partners working in similar activities or locations. This tool will be updated routinely to reflect critical shifts in anti-MDR TB drug access as stakeholders and nations develop new strategies to improve TB programs.
In January of 2017, researchers began the second round of desk review and follow up. Researchers reached out to project leads requesting updates (where necessary) on their respective initiatives. Six contacts have completed a follow up Qualtrics survey, and three have completed interviews with a member of the research team. While the research team has followed up with all original 40 projects and has updated information on the online tool accordingly, the team has also begun to look for other projects that may have recently started and that fall in scope of this initiative. All the data collected in phase two of this project has been added to the master database and has been updated on the mapping website.