According to the World Health Organization (WHO), one third of the world’s population has been infected with tuberculosis. In 2015, more than 10 million people fell ill due to TB, and 1.8 million people died from the disease, including 0.4 million among people with HIV. In that same year, national notification systems missed about 4 million people who developed TB. Today, 35% of deaths among people living with HIV were due to TB.
PSI began implementing TB programs in 2004, expanding our work to 22 countries in Latin America, Asia and Africa. We operate in 26 of the countries with the highest burdens of TB, multidrug-resistant tuberculosis (MDR-TB) or TB/HIV co-infection according to the WHO. 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.
As PSI’s HIV programs move further into biomedical and clinical service delivery, we aim to integrate strong HIV services with TB diagnostics, prevention and treatment. We also have an opportunity to apply our growing strengths in addressing loss-to-follow-up into our TB efforts. This is achieved by offering not only referrals but the full continuum of care, especially to clients with limited access to the nearest clinic.
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 treatment services in countries with high rates of HIV/TB co-infection.
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- 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
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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.
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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.