Engaging the private sector to increase tuberculosis case detection: an impact evaluation study

Khan, Aamir; Khowaja, Saira; Khan, Faisal S.; Qazi, Fahad; Lotia, Ismat; Habib, Ali; Mohammed, Shama; Khan, Uzma; Amanullah, Farhana; Hussain, Hamidah; Becerra, Mercedes C.; Creswell, Jacob; Keshavjee, Salmaan

doi:10.1016/s1473-3099(12)70116-0

Cited by 126 publications

(135 citation statements)

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“…However, our results cover a fairly large catchment area and closely mirror the WHO estimates for the country. We were also not able to test TB patients that receive care in the private sector 14. We were unable to get confirmed data on the smear status of the TB patients.…”

Section: Discussionmentioning

confidence: 94%

Screening for HIV among tuberculosis patients: a cross-sectional study in Sindh, Pakistan

Hasnain

Memon

Memon³

et al. 2012

BMJ Open

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ObjectiveTo describe feasibility and results of systematic screening of tuberculosis (TB) patients for HIV.DesignCross-sectional study.SettingSix selected sentinel sites (public DOTS clinics) in the province of Sindh, Pakistan.ParticipantsAll TB patients aged 16–60 years registered for treatment from April 2008 to March 2012.MeasurementDemographic information of registered TB patients, screening for HIV through rapid testing and confirmation by referral lab of Sindh AIDS Control Program, according to national guidelines.ResultsOf a total of 18 461 registered TB patients, 12 882 fulfilled the inclusion criteria and were given education and counselling. Of those counselled 12 552 (97.4%) were screened for HIV using a rapid test. Men made up 48% of the sample and 76.5% of patients had pulmonary TB. Of the total patients tested, 42 (0.34%) were HIV-positive after confirmatory testing at the Sindh AIDS Control Program Laboratory. Prevalence of HIV among male patients was 0.67% whereas prevalence among female patients was 0.03% (p value <0.001). Prevalence of HIV among pulmonary TB patients was 0.29% and among extrapulmonary TB patients was 0.48% (p value=0.09).ConclusionIn public DOTS clinics in Pakistan it is feasible to test TB patients for HIV. Prevalence of HIV is three times higher among TB patients as compared with the general population in Pakistan. Although the results are not representative of Pakistan or Sindh province they cover a large catchment area and closely match WHO estimate for the country. Routinely screening all TB patients for HIV infection, especially targeting men and ensuring antiretroviral therapy, can significantly improve TB/HIV collaborative activities in Pakistan and identify many cases of HIV, improve health outcomes and save lives.

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Section: Discussionmentioning

confidence: 94%

Screening for HIV among tuberculosis patients: a cross-sectional study in Sindh, Pakistan

Hasnain

Memon

Memon³

et al. 2012

BMJ Open

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“…A year-long Pakistani communications campaign, aimed at improving TB detection rates, advised patients who had a history of cough lasting at least 2 weeks to present to one of 55 private medical facilities. After arrival, patients were screened by community lay-people using a mobile phone-based algorithm to assess both patients and visitors for risk of TB (62). The lay screeners were incentivised with cash rewards for case detection.…”

Section: Resultsmentioning

confidence: 99%

Assessing the impact of mHealth interventions in low- and middle-income countries – what has been shown to work?

Hall

Fottrell

Wilkinson

et al. 2014

Global Health Action

339

274

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BackgroundLow-cost mobile devices, such as mobile phones, tablets, and personal digital assistants, which can access voice and data services, have revolutionised access to information and communication technology worldwide. These devices have a major impact on many aspects of people's lives, from business and education to health. This paper reviews the current evidence on the specific impacts of mobile technologies on tangible health outcomes (mHealth) in low- and middle-income countries (LMICs), from the perspectives of various stakeholders.DesignComprehensive literature searches were undertaken using key medical subject heading search terms on PubMed, Google Scholar, and grey literature sources. Analysis of 676 publications retrieved from the search was undertaken based on key inclusion criteria, resulting in a set of 76 papers for detailed review. The impacts of mHealth interventions reported in these papers were categorised into common mHealth applications.ResultsThere is a growing evidence base for the efficacy of mHealth interventions in LMICs, particularly in improving treatment adherence, appointment compliance, data gathering, and developing support networks for health workers. However, the quantity and quality of the evidence is still limited in many respects.ConclusionsOver all application areas, there remains a need to take small pilot studies to full scale, enabling more rigorous experimental and quasi-experimental studies to be undertaken in order to strengthen the evidence base.

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“…Mobile phones have already been used in TB programs as platforms for data collection and to communicate with patients. [34][35][36] Although neither travel time nor distance was associated with likelihood of completing TB evaluation at these primary health clinics in Uganda, other studies have found that increased travel time as measured by self-report is associated with delays both in seeking and delivering TB care. 8 In the absence of more detailed individual covariates in our study, we propose several possible hypotheses for testing in future studies.…”

Section: Discussionmentioning

confidence: 99%

Investigating Barriers to Tuberculosis Evaluation in Uganda Using Geographic Information Systems

Ross¹,

Cattamanchi²,

Miller³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Reducing geographic barriers to tuberculosis (TB) care is a priority in high-burden countries where patients frequently initiate, but do not complete, the multi-day TB evaluation process. Using routine cross-sectional study from six primary-health clinics in rural Uganda from 2009 to 2012, we explored whether geographic barriers affect completion of TB evaluation among adults with unexplained chronic cough. We measured distance from home parish to health center and calculated individual travel time using a geographic information systems technique incorporating roads, land cover, and slope, and measured its association with completion of TB evaluation. In 264,511 patient encounters, 4,640 adults (1.8%) had sputum smear microscopy ordered; 2,783 (60%) completed TB evaluation. Median travel time was 68 minutes for patients with TB examination ordered compared with 60 minutes without (P < 0.010). Travel time differed between those who did and did not complete TB evaluation at only one of six clinics, whereas distance to care did not differ at any of them. Neither distance nor travel time predicted completion of TB evaluation in rural Uganda, although limited detail in road and village maps restricted full implementation of these mapping techniques. Better data are needed on geographic barriers to access clinics offering TB services to improve TB diagnosis.

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Engaging the private sector to increase tuberculosis case detection: an impact evaluation study

Cited by 126 publications

References 10 publications

Screening for HIV among tuberculosis patients: a cross-sectional study in Sindh, Pakistan

Screening for HIV among tuberculosis patients: a cross-sectional study in Sindh, Pakistan

Assessing the impact of mHealth interventions in low- and middle-income countries – what has been shown to work?

Investigating Barriers to Tuberculosis Evaluation in Uganda Using Geographic Information Systems

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