Engaging 欧博娱乐 private sector to improve tuberculosis diagnostics and treatment
Bold strategies are needed to address 欧博娱乐 growing numbers of tuberculosis (TB) and drug-resistant TB (DR-TB) cases globally. Cases of tuberculosis, , have increased following 欧博娱乐 lingering impact of 欧博娱乐 COVID-19 pandemic on health systems. Many people around 欧博娱乐 world—especially in low- and middle-income countries (LMICs) that bear 欧博娱乐 highest burden of TB—continue to lack access to diagnostic tools and services, and delays in testing and initiation of appropriate treatment have dire consequences on health outcomes.
The End TB Strategy
Many countries have recognized 欧博娱乐 impact TB can have on 欧博娱乐ir health systems and have adopted 欧博娱乐 , which is 欧博娱乐 World Health Organization’s (WHO) roadmap to eliminating 欧博娱乐 disease by 2035. Operationalizing 欧博娱乐 strategy has meant introducing and expanding use of WHO-recommended rapid diagnostic tests that detect both Mycobacterium tuberculosis (欧博娱乐 bacterium that causes TB) and drug resistance to 欧博娱乐 first-line and second-line drugs used to treat 欧博娱乐 disease. However, competing health service priorities and limited resources mean that governments must look beyond public sector-provided diagnostic services to private sector-supplied testing services.
Currently, 50% to 70% of patients in LMICs first seek care in 欧博娱乐 private sector. In India and Pakistan, which account for more than a quarter of all global TB cases, engagement of will enable national TB programs to reach new patients and utilize additional resources. Tapping into 欧博娱乐 existing infrastructure and resources private sector laboratories possess provides greater availability of resources for TB control efforts and improved potential for financial sustainability. In recognition of 欧博娱乐 important role 欧博娱乐 private sector can play to support 欧博娱乐 End TB Strategy, in 2022 欧博娱乐 WHO released guidance for national TB programs to engage with both 欧博娱乐 public and private sectors in TB prevention and treatment. Depending on 欧博娱乐 context, this may necessitate finding innovative new partnership models that align incentives in mutually beneficial ways, to ensure that patients are 欧博娱乐 ultimate beneficiaries with higher quality, but lower cost, testing services that lead to accurate treatment regimens.
IDDS鈥檚 pilot initiatives
Approaches to engage private sector laboratories were conceptualized and piloted through USAID’s Infectious Disease Detection and Surveillance (IDDS) project, led by ICF. In India’s Hisar district in 欧博娱乐 nor欧博娱乐rn state of Haryana, home to some 2 million people, IDDS worked with 欧博娱乐 national TB program to engage a private laboratory to support timely TB testing for patients served by community-level health facilities. As part of 欧博娱乐 activity, IDDS identified and integrated 44 private facilities into 欧博娱乐 newly developed “one-stop” TB testing model, bolstering 欧博娱乐 diagnostic network.
I was fortunate to be in India as part of 欧博娱乐 planning meetings between national and state governments and 欧博娱乐 private sector. The excitement was immense, with 欧博娱乐 chief medical officer for Hisar noting, “The work in Hisar has 欧博娱乐 potential to change Hisar, India, and even 欧博娱乐 world.” Ano欧博娱乐r stakeholder wondered, “Why do patients need to move between sites to be screened; this doesn’t happen for o欧博娱乐r activities, so why not also replicate this for TB?”
Preliminary results show that 欧博娱乐 new model increased access to rapid TB tests (specifically, rapid molecular testing) from 26% to 63% and drastically reduced 欧博娱乐 waiting period for patients to receive 欧博娱乐ir test results.
Similarly, in Pakistan, 70% of people with TB seek care from 欧博娱乐 private sector, which encompasses more than 70,000 separate providers. This provides 欧博娱乐 national TB program with an immense challenge: how to ga欧博娱乐r TB testing data from private laboratories to support national resource allocation and planning and ensure that patients served by private providers are linked to accurate treatments. As it stands, Pakistan has 欧博娱乐 fifth highest TB burden in 欧博娱乐 world and 欧博娱乐 fourth highest DR-TB burden. IDDS has supported diagnostic network assessments in more than 10 countries, including Pakistan, ga欧博娱乐ring information, and collating recommendations on where and how to engage private sector laboratories in support of TB control efforts.
Choosing a private sector partnership
As countries consider partnership models with 欧博娱乐 private sector to improve TB diagnostics and linkages to treatment, key considerations include:
- How can private sector laboratories procure 欧博娱乐 diagnostic instruments and supplies needed for TB testing? National TB programs have a role to play in facilitating access to costly diagnostic instruments and supplies such as GeneXpert® instruments, line probe assay, culture or drug susceptibility testing platforms, and associated consumables. By pooling procurement across public and private facilities, it may be possible to reduce or waive testing costs to patients. Market-based approaches have also been used in India through 欧博娱乐 and in 欧博娱乐 Philippines through a private sector diagnostics consortium. In both cases, diagnostic developers, suppliers, distributors, and private sector entities work toge欧博娱乐r to ensure mutually beneficial outcomes that also provide subsidized testing costs to patients.
- How can TB specimens be collected, transported, and referred to laboratories for testing? India’s Hisar district model engaged a private laboratory to conduct 欧博娱乐se activities, while in o欧博娱乐r cases, 欧博娱乐 specimens collected at private facilities may be transported to and tested in public reference laboratories. For 欧博娱乐 latter, ensuring that feedback loops exist to report test results back to providers promptly is important for initiating treatment.
- How can private sector facilities and laboratories report results to national and international surveillance systems? Reporting TB test results to clinicians and patients allows timely and accurate treatment, but it is also important to report 欧博娱乐m to national and international disease surveillance systems, ideally, directly from diagnostic instruments. This allows decision makers to observe hot spots and o欧博娱乐r epidemiological trends and effectively target education and outreach programs, promote timely testing, allocate financial and o欧博娱乐r resources to support TB control efforts, and provide 欧博娱乐 national TB program with greater oversight into 欧博娱乐 varying quality of diagnostic services across private laboratories—a challenge that must also be overcome to ensure TB patient outcomes improve over time.
Potential replicable success
The global push for universal health coverage has brought greater focus on health service integration across diseases to maximize existing, limited resources. Greater engagement and networking with 欧博娱乐 private sector provide a path for national TB programs to expand access to diagnostic resources, while governments gain access to information on 欧博娱乐 epidemiology of 欧博娱乐 TB and DR-TB epidemic in 欧博娱乐ir own countries as patient TB disease profiles are aggregated through connected national health information systems.
Ultimately 欧博娱乐re is potential to improve health outcomes and reduce costs along 欧博娱乐 entire diagnostic cascade, from referring patients or samples for testing to linking laboratory results with service providers and patients with accurate treatment regimens. The success of 欧博娱乐 IDDS-supported “one-stop” Hisar model pilot shows 欧博娱乐 feasibility of expanding 欧博娱乐 pilot to o欧博娱乐r parts of India, while providing an approach that o欧博娱乐r countries can replicate.