In Asia and Africa, we engage the private health sector to offer high quality TB treatment and use behavior change communication techniques to promote treatment adherence.
Engaging the private health sector to provide high-quality tuberculosis (TB) treatment and promote treatment adherence.
In 2014, the World Health Organization (WHO) estimated the success rate of TB treatment at 83%. However, the gap between new and notified TB cases remains large; an estimated 4.3 million cases of TB went unreported in 2015. While some of this gap is a result of under-reported cases, the burden of undiagnosed – and untreated – TB remains unacceptably high.
In many countries, access to TB diagnosis and treatment remains limited, and quality of care – especially in the private sector where many people with TB first seek care – remains highly variable. As a result, the average time between symptom onset and treatment initiation, globally, is more than one year. For those who are diagnosed, poor quality treatment can cause the emergence of multidrug-resistant TB (MDR-TB). Therefore it is critical to improve quality TB treatment programs.
We provide TB treatment through private sector healthcare providers using our social franchising approach. In Myanmar, we train providers to treat TB and supply them with quality-assured TB drugs through national TB programs. In accordance with national guidelines, TB services are provided free of charge through these private sector networks and providers are given support to ensure that information about treatment initiation and treatment outcomes are appropriately recorded and reported.
In order to ensure treatment adherence, TB patients must be observed taking their drugs each day, especially during the critical first two months of treatment. This approach is called directly-observed therapy short-course (DOTS). Although it allows health workers to confirm that each dose of the treatment regimen is taken, DOTS can be burdensome to clients who must travel long distances to visit their healthcare provider each day.
To decrease this burden, we train community health workers to support patients and private providers. These health workers visit patients in their homes to observe treatment and to counsel clients on the importance of adherence. Counseling is client-centered, taking into account the unique barriers to adherence that each patient may face. In some countries, we also work with pharmacists–who are often located closer to patients than providers–to train them in DOTS. Finally, we reinforce the importance of treatment adherence through more traditional media channels.
Making a Difference
In Myanmar, the Sun Quality Health (SQH) franchise contributes 13% of national TB case notifications each year. Their franchise model was recognized by USAID and WHO Stop TB Partnership as a best practice for community-based TB programming in Myanmar and a model for engaging private providers in quality TB care. PSI has also established a second public-private mix channel for case detection and referral through drug sellers who capture people with suspected TB.