According to the World Health Organization, one third of the world’s population has been infected with tuberculosis. In 2012, nearly 9 million people fell ill due to TB, and there were 1.3 million TB deaths. In that same year, national notification systems missed about 3 million people who developed TB. Today, the illness remains the leading cause of death for people living with HIV.
We began implementing TB programs in 2004 and have expanded our work to 22 countries in Latin America, Asia and Africa. These programs include:
- Working with the private and public sectors to strengthen health systems’ ability to detect cases of TB, initiate and ensure completion of treatment, and integrate TB/HIV services.
- Working with Ministries of Health to engage private-sector health workers in the provision of high-quality TB care.
- Training providers to offer high-quality TB services, including screening, diagnosis and treatment. Throughout Asia and Africa, we have extensive expertise training and supporting a variety of care providers, including general practitioners, pharmacists and traditional healers.
- Providing ongoing supportive supervision so that providers continue to offer quality care and notify cases to national TB programs.
- Engaging small-scale providers with social franchising. These outlets are often difficult to reach with other private-public mix models.
We also use mass media and mid media communications to promote TB care-seeking behavior and encourage treatment adherence. Messages are designed to address key determinants of these behaviors, including knowledge, skills and self-efficacy to seek out and adhere to TB treatment. We also train outreach workers to conduct interpersonal communication activities with communities at high risk of TB infection and to offer screening services where appropriate. This active case finding approach includes contact tracing of identified TB cases.
Because people living with HIV are especially vulnerable to TB infection and death, we leverage our existing HIV programs in more than 60 countries to integrate TB screening activities in its fixed and mobile HIV testing and counseling facilities. Individuals with symptoms suggestive of TB are linked to quality-assured diagnostic services in the public or private sectors. Once diagnosed, clients are then linked to TB treatment and outreach workers work to ensure that individuals adhere to treatment through completion.
In 2013, our TB programs prevented 153,500 DALYs in 13 countries.
Our TB work is focused on the following areas. Click on a link to learn more about our interventions:
- Engaging the Private Sector: We support global efforts to engage private sector health care workers in the provision of high-quality TB care.
- Case Finding: We use our expertise in behavior change communication and community-based outreach to increase TB case detection.
- Treatment: We engage the private health sector to offer high quality TB treatment and use behavior change communication techniques to promote treatment adherence.
- TB/HIV Integration: We integrate TB case finding with HIV testing and counseling services in high TB burden countries.
- Barriers to Provider Initiated HIV Testing and Counseling (PITC) Among TB Patients in Myanmar
In Myanmar, we introduced provider-initiated testing and counseling (PITC) to increase the detection of HIV among TB patients. As part of this work, we conducted research to identify barriers to PITC-uptake among TB patients
- Comparison of Different Models for Active TB Case Finding in Zimbabwe
We recently evaluated our efforts to increase TB case detection among people living with HIV in Zimbabwe using routine data collected during service delivery. The evaluation found that offering TB screening and diagnosis services as part of the delivery of HTC services was more effective than broader community outreach efforts
- TB Case Detection via Private Pharmacies in Lao PDR
In Laos, we use a tailored incentive scheme to increase case detection among pharmacists in the private sector.
- Engagement of Non-Allopathic/AYUSH Health Care Providers in TB Care and Control: Results of Two Years of Implementation
In India, many people seek care from practitioners of alternative medicine. We sensitize these providers about TB, training them to detect the symptoms of TB and to link clients to laboratory diagnostics available free of charge in the public sector. This ensures that patients with TB are diagnosed as quickly as possible and linked to quality TB treatment. As many as 29 percent of all patients referred by these providers tested positive for TB.
- Private Sector Healthcare Myanmar: Evidence from the ‘Sun’ Social Franchise
As an evidence-based model, social franchising puts high quality healthcare within the reach of people in need around the world. This report showcases results from four studies led by researchers from PSI, the University of California, San Francisco (UCSF), and Johns Hopkins University, which demonstrate how social franchising networks, like PSI/Myanmar's Sun Quality Network, improve the quality of health service delivery and health outcomes at-scale, cost effectively and equitably.
- Bulham Bhai — India mass media campaign to increase TB care seeking
The campaign centers around the superhero Bulgam Bhai (Mr. Sputum in English). Bulgam Bhai locates people coughing and advises them to get their sputum (saliva mixed with mucus) checked for TB if they have been coughing for more than two weeks.
- USAID Dialogue on HIV and TB Project
In community outreach activities, key populations (including people who inject drugs, men who have sex with men, sex workers, prisoners, migrants and people living with HIV) are screened for TB and individuals with symptoms suggestive of pulmonary TB are linked to diagnostic services.
- Equity and the Sun Quality Health Private Provider Social Franchise: comparative analysis of patient survey data and a nationally representative TB prevalence survey
With the Global Health Group at UCSF, Myanmar Ministry of Health and WHO, we conducted a study to determine whether the Sun Quality Health social franchise was effectively reaching its goal of serving the poor. The study found that SQH patients in urban areas were poorer than individuals with TB in the general population, suggesting that the franchise successfully reached the poor.
- The Social Marketing Evidence Base: a Web-Based Resource on Social Marketing Effectiveness in Global Health
PSI is one of the largest social marketing agencies in the world but is challenged to demonstrate the effectiveness of its strategies for achieving health improvements in low- and middle-income countries. In response, PSI created the Social Marketing Evidence Base (SMEB), a web-based database of systematically reviewed literature on the effectiveness of social marketing in HIV/STIs, tuberculosis, reproductive health, malaria, and child survival.
- Drivers of Treatment Interruptions Among Private-Sector TB patients in Myanmar
At the 2013 Union World Conference, PSI/Myanmar presented data on factors contributing to treatment interruption among TB clients who receive care through the Sun Quality Health social franchise: