Search

Abstract Background Private providers (PPs), rather than public facilities, are often the first point of contact in the health system for people with tuberculosis (TB). However, PP’s potential for enhancing TB detection remains underutilized. Methods TB REACH is an initiative of Stop TB Partnership focused on improving TB detection and notification. We analyzed the results of interventions using private provider engagement (PPE) to impact TB detection and notification across four TB REACH funding waves from May 2018 through March 2022. Results Overall, 35 projects documented screening of 13,038,586 people for TB, referral of 384,364 (3% of those screened) for diagnostic testing, and testing of 332,266 (86%) people. In total, 64,456 all forms of TB were diagnosed, and 62,830 (97% of those diagnosed) were linked to treatment. To diagnose one person with TB, the overall number needed to screen and test was, respectively, 281 (range across projects: 2–8,705) and 7 (range across projects: 1–24). Twenty-five projects mapped 69,187 PPs, both formal and informal, and engaged 21,206 (31%) providers during the intervention period, 12,211 (58%) of whom actively referred at least one person with TB symptoms during the intervention period. During the implementation period, TB notifications in the intervention areas increased by 25% (n = 61,123; from 246,845 to 307,968), with 20% of the total TB notifications attributed to the PPE projects. The mean and median cost per person started on treatment through the PPE projects was USD 221 and USD 481 (range across projects: 23 − 8,689). Conclusions Our findings suggest that structured and targeted PPE enhances TB case finding and contribute in closing the gap of missing cases. These results emphasize the need for wider implementation and scale-up of PPE in the TB response.

Objective To quantify the prediagnostic loss to follow-up (PDLFU) in an active case finding tuberculosis (TB) programme and identify the barriers and enablers in undergoing diagnostic evaluation.Design Explanatory mixed-methods design.Setting A rural population of 1.02 million in the Samastipur district of Bihar, India.Participants Based on their knowledge of health status of families, community health workers or CHWs (called accredited social health activist or locally) and informal providers referred people to the programme. The field coordinators (FCs) in the programme screened the referrals for TB symptoms to identify presumptive TB cases. CHWs accompanied the presumptive TB patients to free diagnostic evaluation, and a transport allowance was given to the patients. Thereafter, CHWs initiated and supported the treatment of confirmed cases. We included 13 395 community referrals received between January and December 2018. To understand the reasons of the PDLFU, we conducted in-depth interviews with patients who were evaluated (n=3), patients who were not evaluated (n=4) and focus group discussions with the CHWs (n=2) and FCs (n=1).Outcome measures Proportion and characteristics of PDLFU and association of demographic and symptom characteristics with diagnostic evaluation.Results A total of 11 146 presumptive TB cases were identified between January and December 2018, out of which 4912 (44.1%) underwent diagnostic evaluation. In addition to the free TB services in the public sector, the key enablers were CHW accompaniment and support. The major barriers identified were misinformation and stigma, deficient family and health provider support, transport challenges and poor services in the public health system.Conclusion Finding the missing cases will require patient-centric diagnostic services and urgent reform in the health system. A community-oriented intervention focusing on stigma, misinformation and patient support will be critical to its success.

Navigating the Indian health system is a challenge for people with tuberculosis (TB) symptoms. The onus of organizing care is on the patient and their families alone. Factors like gender discrimination and opportunity costs further aggravate this. As a result, people may not complete the diagnostic and treatment pathway even though they experience poor health. Navigators can aid in the pathway’s completion. We implemented two projects in India—a public sector intervention in Bihar, with a population of 1.02 million, and a private sector intervention in Andhra Pradesh (AP), with a population of 8.45 million. Accredited Social Health Activists (ASHAs) of the public health system in Bihar and local field officers in AP facilitated the patients’ navigation through the health system. In Bihar, ASHAs accompanied community-identified presumptive TB patients to the nearest primary health center, assisted them through the diagnostic process, and supported the patients throughout the TB treatment. In AP, the field officers liaised with the private physicians, accompanied presumptive patients through the diagnosis, counseled and started treatment, and followed-up with the patients during the treatment. Both projects recorded case-based data for all of the patients, and used the yield and historical TB notifications to evaluate the intervention’s effect. Between July 2017 and December 2018, Bihar confirmed 1650 patients, which represented an increase of 94% in public notifications compared to the baseline. About 97% of them started treatment. During the same period in AP, private notifications increased by 147% compared to the baseline, and all 5765 patients started treatment. Patient navigators support the patients in the diagnostic and treatment pathways, and improve their health system experience. This novel approach of involving navigators in TB projects can improve the completion of the care cascade and reduce the loss to follow-up at various stages.

Abstract Background No guidelines exist on assessing ventilation through air changes per hour (ACH) using a vaneometer. The objective of the study was to evaluate the position and frequency for measuring air velocity using a vaneometer to assess ventilation with ACH; and to assess influence of ambient temperature and weather on ACH. Methods Cross-sectional survey in six urban health facilities in Kampala, Uganda. Measurements consisted of taking air velocity on nine separate moments in five positions in each opening of the TB clinic, laboratory, outpatient consultation and outpatient waiting room using a vaneometer. We assessed in addition the ventilation with the “20% rule”, and compared this estimation with the ventilation in ACH assessed using the vaneometer. Results A total of 189 measurements showed no influence on air velocity of the position and moment of the measurement. No significant influence existed of ambient temperature and a small but significant influence of sunny weather. Ventilation was adequate in 17/24 (71%) of all measurements. Using the “20% rule”, ventilation was adequate in 50% of rooms assessed. Agreement between both methods existed in 13/23 (56%) of the rooms assessed. Conclusion Most rooms had adequate ventilation when assessed using a vaneometer for measuring air velocity. A single vaneometer measurement of air velocity is adequate to assess ventilation in this setting. These findings provide practical input for clear guidelines on assessing ventilation using a vaneometer. Assessing ventilation with a vaneometer differs substantially from applying the “20% rule”.

BackgroundIn Pakistan, many tuberculosis (TB) cases are not reported to the national surveillance system. An active case finding strategy in the form of conventional (simple) or innovative (infotainment) chest camps can contribute to diagnosing these missed cases.ObjectiveTo compare the yield in terms of TB patients detected at a simple chest camp (SCC) versus an infotainment chest camp (ICC) in rural areas.MethodsA cluster randomized controlled trial with 2 parallel arms was conducted in 4 districts of Pakistan from June 2012 to May 2013. Rural neighborhoods (n = 318) were randomly allocated in a ratio of 1:3 to receive either SCC or ICC. Incidence of TB (all forms and sputum smear positive [SS+]) and number needed to screen (NNS) to diagnose 1 TB case were calculated. Cluster analysis was done according to intention to treat and risk ratio (RR), and 95% confidence intervals (CIs) were calculated.FindingsA total of 3086 participants were tested at the SCC and 9029 at the ICC, of whom 38.5% were female. Mean age was 37.4 ± 15.9 years. Incidences of previously undiagnosed TB (all forms) for SCC and ICC were 23.6 (95% CI 20.04-27.4) and 22.1 (95% CI 20.3-24.1) per 100,000 population ('P' = .42), SS+ TB 22.5 (95% CI 19.3-26.1) and 21.6 (95% CI 19.8-23.6) ('P' = .67), respectively. NNS to diagnose 1 TB case were 260 (95% CI 234.3-289.6) and 258 (95% CI 233.3-287.9) for SCC and ICC, respectively ('P' = .9). RRs for all forms of TB and SS+ TB in SCC compared to ICC were 0.94 (95% CI 0.73-1.19) and 0.95 (95% CI 0.74-1.22) and 'P' values were .58 and .71, respectively.ConclusionsBoth types of chest camps are equally effective in active case finding of previously undiagnosed TB cases in rural areas in 2 provinces in Pakistan.

After many years of TB ‘control’ and incremental progress, the TB community is talking about ending the disease, yet this will only be possible with a shift in the way we approach the TB response. While the Asia-Pacific region has the highest TB burden worldwide, it also has the opportunity to lead the quest to end TB by embracing the four areas laid out in this series: using data to target hotspots, initiating active case finding, provisioning preventive TB treatment, and employing a biosocial approach. The Stop TB Partnership’s TB REACH initiative provides a platform to support partners in the development, evaluation and scale-up of new and innovative technologies and approaches to advance TB programs. We present several approaches TB REACH is taking to support its partners in the Asia-Pacific and globally to advance our collective response to end TB.

Healthcare Workers (HCWs) have a higher frequency of TB exposure than the general population and have therefore an occupational TB risk that infection prevention and control (IPC) measures aim to reduce. HCWs are crucial in the implementation of these measures. The objective of the study was to investigate Mozambican HCWs' perceptions of their occupational TB risk and the measures they report using to reduce this risk. In addition, we explored the challenges HCWs encounter while using these TBIPC measures.Focus group discussion. Analysis according content method.Four categories of HCWs: auxiliary workers, medical (doctors and clinical officers), nurses and TB program staff.HCWs are aware of their occupational TB risk and use various measures to reduce their risk of infection. HCWs find it challenging to employ measures that minimize such risks and a lack of clear guidelines contributes to these challenges. HCWs' and patient behavior further complicate the use of TBIPC measures.HCWs in Mozambique perceive a high occupational risk of TB infection. They report several challenges using measures to reduce this risk such as shortage of material, lack of clear guidelines, insufficient motivation and inadequate training. Robust training with motivational approaches, alongside supervision and support for HCWs could improve implementation of TBIPC measures. Healthcare management should address the areas for improvement that are beyond the individual HCW's control.