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

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Systems Research

Background:

• Tuberculosis (TB) control is challenging in high-burden countries where the private sector manages most patient care.
• Evaluating innovative strategies to improve TB case detection within the private healthcare system is crucial.

Purpose of the Study:

• To assess the impact of a multifaceted case-detection strategy on tuberculosis notifications in the private sector of Karachi, Pakistan.

Main Methods:

• A year-long communication campaign targeted private family medical clinics and a hospital.
• Community laypeople acted as screeners using mobile phone algorithms, incentivized for case detection.
• The primary outcome measured was the change in TB notifications to the National Tuberculosis Programme (NTP) from 2010 to 2011.

Main Results:

• Tuberculosis case notification in the intervention area doubled from 2010 to 2011, representing a 2.21-fold increase relative to the control area.
• Over 388,000 individuals were assessed at family clinics, leading to the detection of 2416 TB cases.
• Pulmonary TB notifications at the intervention hospital increased significantly, by 3.77 times for adults and 7.32 times for children.

Conclusions:

• Multifaceted TB case-finding strategies involving the private sector, lay community members, mobile technology, and incentives can substantially increase case notification.
• These novel approaches are effective in dense urban settings for improving tuberculosis surveillance and care access.