Strengthening TB care pathways: Integrating informal and AYUSH practitioners for early diagnosis and referral

Tuberculosis (TB) continues to be the leading cause of death from infectious diseases, disproportionately affecting populations in low- and middle-income countries, where diagnostic and financial barriers impede timely care. While alternative treatments may offer symptomatic relief, the cornerstone of TB management remains anti-tubercular therapy (ATT) as recommended by the World Health Organization (WHO). Yet, many individuals with TB-like symptoms first consult traditional healers and AYUSH (Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy) practitioners, resulting in delays in diagnosis and treatment initiation. This quasi-experimental study evaluated the impact of strengthening linkages between non-allopathic and allopathic providers, through formal referral systems, alongside the implementation of a free chest X-ray (CXR) screening system for presumptive TB patients. A mixed methods design found the significant role of friends and family in influencing care-seeking patterns, while a regression analysis within a Difference-in-Differences approach found the intervention to reduce diagnostic delay by over eight days (-8.6, 95% CI: -16.6, -0.5). The accelerated pathway to diagnosis was observed irrespective of which provider was first visited by the patient, holding promise for future such interventions, especially in high-burden regions, with significant reliance on informal providers.