Finding the Missing Patients With Tuberculosis: Lessons Learned From Patient-Pathway Analyses in 5 Countries

Area of Science:

• Global Health
• Infectious Diseases
• Public Health Policy

Background:

• Millions of tuberculosis (TB) cases remain unreported annually despite diagnostic and treatment advancements.
• Patient pathway analysis (PPA) is a tool to understand TB care-seeking behaviors and service availability.
• Identifying gaps in patient pathways is crucial for finding "missing" TB patients.

Purpose of the Study:

• To aggregate and compare patient pathway analyses from five countries: Kenya, Ethiopia, Indonesia, the Philippines, and Pakistan.
• To assess the alignment between patient TB care-seeking patterns and available diagnostic and treatment services.
• To identify opportunities for improving TB case detection and reporting.

Main Methods:

• Comparative analysis of patient pathway data from case studies in five diverse countries.
• Evaluation of care-seeking patterns at different facility levels (0, 1, 2) and sectors (public vs. private).
• Assessment of diagnostic (e.g., GeneXpert) and treatment capacity in relation to patient flow.

Main Results:

• Only 24% of TB patients initiated care at facilities with diagnostic capacity.
• Most patients (66%) sought care in private facilities with limited diagnostic capabilities.
• Significant subnational variations in care-seeking and service availability were observed.
• Tuberculosis treatment capacity correlated with diagnostic capacity, with limited GeneXpert availability in some areas.

Conclusions:

• Patient pathway analysis is a valuable tool for TB program planning and service delivery optimization.
• Closing the diagnostic gap and engaging the private sector are essential for patient-centered TB care.
• Differentiated, localized approaches are necessary due to substantial subnational differences in patient pathways.