Our patient-centered approach dramatically increases TB screening rates and preventive therapy uptake especially for children under 5
From August to November 2024 we designed and ran a pilot program at the Federal Government TB Centre in Rawalpindi - one of the largest TB hospitals in Pakistan.
The program work on the ground was delivered by our partner Marie Adelaide Leporosy Centre working with the kind permission of the Pakistan Ministry of Health.
Before the pilot, the hospital had been offering some TPT services to household contacts of those living with TB, known as "index patients". However, they did not have have paediatric services. They had a generous donation of motorbikes from the WHO and wished to do more community outreach.
We designed a household screening and TPT program which involved:
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Launching a new household visit program to symptom screen children under 5 for TB and deliver TPT to them at home
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Establishing an arrangement for referrals for paediatric services
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Providing capacity building for the hospital (refresher training, new counselling materials and improved administrative processes for contact tracing)
For those under 5 years old, our innovative teleconsultation approach meant we could rule out TB using a symptom screen during a visit to the household, in line with Pakistan and WHO guidelines. We brought the care to people in their own homes removing barriers to accessing life-saving medicine.
For those over 5 years old, we introduced counselling, a referral form and reminder phone calls to provide them with the information and encouragement necessary to visit the hospital and get screened for TB.
Our pilot program worked with 167 people living with TB and their 950 household contacts. Even with low costs, with patient-centered counselling and bringing care to people's homes, our program was able to achieve very high rates of TB screening and evaluation.
30%
Of household contacts of all ages were evaluated for TB.
87%
Of household contacts under 5 years old were evaluated for TB.
Uptake of TPT was extremely high. Future work will focus on ensuring this carries through into taking and completing the medicine until the end of the course.
100%
Uptake of TPT of those found eligible of all ages.
278
Started TPT in the 2 months of the pilot compared to 11 people in the 3 months before the pilot.
We estimate that this program is highly cost-effective in line with some of the best global health programs.
We plan to extend and expand this program to reach even more people in Pakistan as fast as we can.
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