Engaging the Private Sector to Increase Tuberculosis Case Detection: An Impact Evaluation Study

"Novel approaches to tuberculosis case-finding involving the private sector and using laypeople, mobile phone software and incentives, and communication campaigns can substantially increase case notification in dense urban settings."

This study evaluated a multifaceted case-detection strategy in Karachi, Pakistan, designed to help clinics find people with tuberculosis (TB) to engage them in treatment, through a series of communication interventions including public service messages and engagement of the private sector in an effort using mobile phones. Mobile phones and financial incentives helped a network of private clinics serving economically poor communities find people with TB. This study was funded by the TB REACH initiative of the Stop TB Partnership.

From the study "A year-long communications campaign advised people with 2 weeks or more of productive cough to seek care at one of 54 private family medical clinics or a private hospital that was also a national tuberculosis programme (NTP) reporting centre. Community laypeople participated as screeners, using an interactive algorithm on mobile phones to assess patients and visitors in family-clinic waiting areas and the hospital's outpatient department. Screeners received cash incentives for case detection. Patients with suspected tuberculosis also came directly to the hospital's tuberculosis clinic (self-referrals) or were referred there (referrals)."

The clinics provided community members with electronic scorecards on mobile phones, which they used to identify people who should get a TB test. In addition, posters, television advertisements, and flyers encouraged people with a persistent cough to visit their local clinic for TB testing. As a result of these activities, the project identified 3,140 people with TB among nearly one million people in the Korangi and Bin Qasim neighbourhoods of Karachi. 

The study measured the overall effect of the intervention strategy by comparing the percentage change in case notifications by NTP reporting centres (2011 relative to 2010) and in annual case notification rates (2011 relative to 2008-2010) in the intervention versus control areas. In a neighbouring control area, the number of people referred for treatment decreased by 9%. The number of case notifications doubled in the intervention area.

The study concludes: "Engagement of community members as drivers of case detection, and intermediaries such as Indus Hospital as facilitators, can create highly productive links between the public sector, private practitioners, and communities. In this study, family doctors enthusiastically adopted standard-of-care practices for tuberculosis case detection and treatment. With free access for their patients to diagnosis and treatment facilities through NTP partners, family practices can be a force for social change."