We use our expertise in behavior change communication and community-based outreach to increase TB case detection.
About 3 million people who developed tuberculosis in 2012 were missed by national notification systems. The public health impacts of missing such a large number of cases are severe and include increased morbidity and mortality, increased transmission of TB and –potentially– increased emergence of multi-drug resistant TB.
Based on qualitative research with target populations, our advocacy, communication and social mobilization activities use a variety of channels, including mass media, mid media and interpersonal communication to promote care-seeking behavior increase knowledge about TB symptoms, and encourage treatment adherence. Globally, we have implemented TB behavior change communication activities in Kenya, Pakistan, Myanmar, Vietnam, India, Kazakhstan, Kyrgyzstan, Tajikistan, Laos, Rwanda, Swaziland, Lesotho, Mali, Guinea, South Africa, Ethiopia, Mozambique, Zambia and Zimbabwe.
In many countries, we use an active case finding strategy to reach the missing TB cases. In Vietnam, Zimbabwe, Myanmar, Laos, Guinea and India, outreach workers who lead interpersonal communications activities screen individuals at high risk for TB. Outreach workers will refer individuals with symptoms suggestive of TB to a nearby diagnostic facility. In Laos, we also use a contact tracing approach in which outreach workers screen household members of identified TB cases.
In other countries, such as Pakistan, mass and mid media activities mobilize communities for “screening events” through which large numbers of high-risk individuals are screened in a single day and individuals with symptoms of TB are linked to a nearby diagnostic facility for further care. In Zimbabwe, TB diagnostic services–including LED microscopy and GeneXpert MTB-Rif technology–have been integrated with HIV testing and counseling services to increase TB case detection among people living with HIV.
Our work to engage the private sector also seeks to improve TB case detection. Many private providers are already seeing TB patients, but these patients are often receiving treatment outside of national guidelines and are not notified to national TB programs as TB cases. Through intensive efforts to increase quality of care in the private sector, we ensure that TB cases are appropriately and systematically notified to national TB programs, helping close the gap of more than 3 million missed cases.
Making a Difference
In India, we collaborated with the International Union Against Tuberculosis and Lung Disease, and the BBC World Trust to develop a 360-degree campaign to increase TB care seeking behavior. 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. The campaign was adopted by the Ministry of Health to broadcast nationally. To see Bulgam Bhai in action, check out this commercial: