Precision public health is key to closing the global TB care seeking gap

Why do people not seek care when they have symptoms suggestive of TB?

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Study Findings: Employed men do not seek care because of low-risk perception and time constraints

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Implications: We must bring the right TB interventions to the right people at the right time

Global TB programs should adopt a user-centric, precision public health approach that can increase care-seeking and close the TB gap. This means moving beyond a one-size-fits-all approach to target specific groups with specific interventions that address their identified barriers. This approach is based on asking three key questions that apply to nearly every public health program:

  1. How and where to reach them? We need to reach people where they are. Depending on the context, this may include congregate settings such as communities, churches, and workplaces or targeting them through mobile phones. In Chennai, given the highly mobile nature of target groups, CHAI and Surgo are partnering with the government to pilot innovative digital channels and target new in-person settings to reach presumptive TB patients. Through these channels, we will explore targeted interventions such as customized messages to encourage care-seeking and tools to provide information on convenient TB services. This will include the ability to schedule appointments and/or receive reminders to go and seek care.
  2. With what services? In addition to routine services, we need to make it as easy and convenient as possible to seek care. Taking a customer-centric approach could include door-to-door services, weekend and after-hours services, and workplace screenings. It would require a shift from largely facility-centric models to more flexible, decentralized, community-based service. In the era of COVID-19 and social distancing, digital entry points and telehealth can play a bigger role in target group mobilization and service provision. While telehealth is already being used for TB treatment and adherence counseling, it can also be a low-cost, remote alternative to conduct TB symptom screening, triage, and testing referrals.

Next Steps: Implement, measure, scale, and replicate

We see great potential in applying a precision public health approach for TB. In Chennai, we are currently designing and implementing approaches to target specific groups (employed men) with customized interventions using novel channels to meet them where they are, including digital means. We are also testing models for delivering convenient, and flexible TB screening and testing services that are available for them when they do seek care.

This work is a partnership between Surgo Foundation, Clinton Health Access Initiative, and the Greater Chennai Corporation.

Co-Authored by: Sema Sgaier, Co-Founder and Executive Director, Surgo Foundation, and Harkesh Dabas, CHAI Vice President and Country Director — India.

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