Solthis Solidarité Thérapeutique et Initiatives pour la Santé

International solidarity NGO

Created by research physicians,

Solthis contributes to improve health for all

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The Concerns

Tuberculosis occupies a singular place among large-scale epidemics. Certainly, the number of cases of tuberculosis is very gradually decreasing around the world, and the rate of mortality fell 45% between 1990 and 2013. But in 2013, 9 million people developed tuberculosis and 1.5 million died from it. More than 95% of cases of tuberculosis and deaths come from countries with low or moderate income.

However, the infectious agent, the tuberculosis bacterium (Mycobacterium tuberculosis) that causes the illness, was identified in 1882 along with its mode of transmission -airborne, though person-to-person contact with infected people- and an effective treatment is available for free worldwide, which is atypical for such a large-scale epidemics.

This paradoxical situation is explained by the very high prevalence of the infection, as it's estimated that a third of all people are infected with tuberculosis bacteria, even if only 5% of people will actually develop the disease at some point in their life, sometimes years after contact with a contagious person.

Children under 5 and people infected with HIV are particularly vulnerable populations, with a 5 to 30 times elevated risk of developing the disease. Tuberculosis diagnosis is difficult and often comes late, when people are the most contagious, allowing the epidemic to continue. Moreover, children under five and people infected with HIV frequently have a disseminated form of the disease, which is more serious and very difficult to diagnosis with standard methods. New technology allowing for rapid diagnosis is being developed and represents an important advance. Treatment, which consists of a combination of four medications over six months, is often difficult to administer in its entirety, which leads to the development of treatment-resisted tuberculosis. In 2013, 480,000 people developed multidrug-resistant tuberculosis, for which diagnosis and treatment is more difficult, and 9% of them developed extensively drug-resistant tuberculosis (which resists all standard treatment), for which the vital prognosis is very grim.


Tuberculosis and HIV

Tuberculosis and HIV mutually accelerate their progression.  People living with HIV have a much higher risk than others of developing the active disease. In 2013, an estimated 1.1 million new cases of tuberculosis were reported in people living with HIV, 78% of them living in Sub-Saharan Africa.

Preventative treatment for tuberculosis has demonstrated the possibility of limiting the epidemic, but it is still little used. Mortality related to tuberculosis is also elevated in people living with HIV: around 360,000 people died in 2013 of tuberculosis associated with HIV, which makes it the No. 1 cause of mortality in people infected with HIV.


Solthis' action

Access to preventative treatment and diagnosis for tuberculosis in people infected with HIV and children under five remains one of the major challenges in countries with limited resources. Solthis is leading projects in operations research to evaluate the performance and cost/efficiency for different tuberculosis testing strategies for people living with HIV, particularly in Niger and Guinea. Solthis is also working to develop access to preventative treatment for adults and children in Guinea.


Country action




Health priority


Associated contents

Solthis' Report: “Managing Risk in Fragile States: Putting Health First! Optimising the Efficiency of the Global Fund’s Grants”

2014 |  Scientific Papers |  , ,


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“Managing Risk in Fragile States: Putting Health First!

Optimising the Efficiency of the Global Fund's Grants”

This evidence-based report is the result of a work over several months, including 4 missions (Guinea, Mali, Niger and Sierra Leone) and interviews with 140 stakeholders. Through this work, we identified bottlenecks in the implementation of the Global Fund's grants in the field, showing that the Global Fund's Risk Management Policy is not well-adapted to fragile states. The additional safeguard measures which have been put in place by the Secretariat after the investigations of the Office of the Inspector General were meant to mitigate the financial risks and to reassure donors. However, experiences in challenging operating environments clearly show that these measures are mainly focused on financial risks and have caused significant malfunctions that jeopardise both the impact and the sustainability of the programmes. In order to make progress and to cope with the challenges specific to fragile states, we think it is now time for the Board members and the donors of the Global Fund to opt for an ambitious and innovative policy, which would put financial risk at its proper place: behind risks to public health. The main recommendations we are addressing in the report aim to place the public health risk at the centre of the mechanism, by:
  • Improving the balance between the analysis and the management of the different risks.
  • Simplifying and clarifying the control procedures: limit the number of contractors and the levels of validation.
  • Defining indicators or objectives for terminating additional safeguard measures to encourage appropriation and capacity building.
  • Investigating the possibility of an increased presence of the Global Fund in the field, by missions of several weeks or several months.
  • Adapting the indicators and procedures of performance-based funding and accountability measures to fragile states.
Full version of the report in English here You can also read our 4-pages booklet here The article of Altermondes dedicated to this topic and the interview of the author Hélène Roger

  Download resources

3rd Scientific Sessions – Niamey, October 2009



The Scientific Days, organized by the ULSS and CMT, in partnership with Solthis and GIP Esther, took place on 2 and 3 October 2009 in Niamey in the presence of Professor Katlama (Solthis President), Prof. Brucker (Treasurer Solthis and CEO of Esther) but also of Dr Kassi (Ivory Coast) and Professor Toure (Senegal). More than 250 physicians, health professionals, representatives of the fight against HIV, tuberculosis in Niger attended these days. Many topics on Chess therapeutic Opportunistic Infections, PMTCT, Accidents of exposure to blood and the delegation of tasks were discussed.


XVth ICASA – Dakar, December 2008

2008 |  Posters


HIV/AIDS care and follow-up on a national scale in low resource settings: experience of the Niger Initiative on Antiretroviral Access (INAARV), Niger Author(s) : M. Ide, Y. Madec, M. Boubacar, E. Adehossi, C. Dezé, GM. Lawal, O. Amadou, S. Diallo, C. Pizzocolo, IA. Touré, S. Mamadou, C. Katlama and the National Technical Committee Download the presentation   Pilot cell comprehensive care: a multidisciplinary service orientation and listening PHAs, Niger Author(s) : A. Alzouma, C. Dezé, B. Sabo, M. Bako, S. Maman, I. Mourtala, M. Goundara, F. Djermakoye, M. Ide, F. Aeberhard Download the presentation   The impact of prior recourse to traditional medicine on the out-of-pocket expenditure of HIV/AIDS patients in Niger Author(s): S. Walker, S. Tchiombiano, A. Maiga, R. Hassane, M. Idé, AH. Souna, V. Bignon, O. Weil, L. Pizarro Download the presentation   Incidence and risk factor for tuberculosis (TB) in HIV patients on ART, Niger Author(s): A. Foucher, Y. Madec, S. Diallo, Z. Thiousso, I. Dillé, S. Gambo, HA. Souna, A. Oumarou, A. Manou, GM. Laoual, Al. Touré, C. Pizzocolo, L. Pizarro, A. Fontanet Download the presentation   Decentralized access to triple therapy and viral load monitoring in West Africa (Mali) Author(s) : A. Akondé, Y. Madec, AB. Dicko, I. Haidarra, I. Katile, B. Diarra, M. Kye, A. Doumbia, C. Pizzocolo, C. Katlama and the Segou Medical Technical Committee Download the presentation   A method of HAART decentralization in rural areas: Solthis' experience in Segou (Mali) Author(s) : P. Teisseire, A. Akondé, C. Pizzocolo, S. Calmettes, S. Dalglish, N. Bodo, L. Pizarro Download the presentation   Prevention of mother-to-child transmission of HIV (PMTCT) in a rural setting : the experience of the Segou region in Mali Author(s) : CD. Traoré, A.akondé, T. Samake, T. Traoré, Y. Coulibaly, O. Coulibaly, A. Sidibé, D. Germanaud, Z. Traoré, A. Maiga, AG. Marcelin, C. Pizzocolo, C. Katlama and the Segou Medical Technical Committee Download the presentation   Appraisal of treatment modification in HIV patient follow-up in the region of Segou (Mali) Author(s) : J. Landier, A. Akondé, C. Pizzocolo, I. Haidara, M. Drabo, L. Pizarro, A. Fontanet, C. Katlama, Y. Madec Download the presentation   Etude virologique chez des sujets VIH-1 suivis à Madagascar Author(s) : F. Lamontagne, S. Andriantsimietry, ML. Chaix, JP. Viard, M. Randria, J. Nely, S. Randriamampionona, C. Aguilar, S. Royer, C. Pizzocolo, LR. Razanakolona, C. Rouzioux Download the presentation

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