Supporting tuberculosis program in active contact tracing: a case study from Pakistan

Abstract

Tuberculosis (TB) is on the rise in Pakistan and there could be multiple reasons including poverty, difficulty in access to TB treatment services, non-compliance with treatment, social stigma etc. According to the TB program managers, limited treatment and testing sites for tuberculosis and lack of trained human resources play a major role in compromising TB management. A major lacuna in the TB control program is the absence of active contact tracing strategy. This is essential for a disease where positive cases are known to be able to infect a further 10‒15 individuals in a year. Tackling tuberculosis in Pakistan has been beleaguered by funding challenges and other systems’ bottlenecks such as lack of skilled human resources and insufficient supply of medicines, despite the fact that disease burden is one of the highest in the world. Although it is a notifiable disease, active case finding, contact tracing and reporting is notoriously low throughout the country. Access to diagnostics and treatment facilities has been limited and stigma attached to the disease remains deeply entrenched among the communities. Researchers have shown that enhanced and active approaches to contact investigation effectively identifies additional patients with TB among household contacts at a relatively modest cost. USAID’s Integrated Health Systems Strengthening and Service Delivery Activity extended support to the Health Departments of Sindh and Khyber Pakhtunkhwa provinces. In collaboration with the two provincial TB programs, community based active contact tracing was conducted on 17,696 individuals, based on the index cases. Among the contacts traced, 243 cases were diagnosed as drug sensitive or drug resistant TB. Awareness sessions were conducted to sensitize people on the various aspects of disease and importance of getting tested. The project also supported establishing three satellite Programmatic Management of Drug Resistant Tuberculosis (PMDT) sites for drug resistant TB treatment, enhancing the programs’ diagnostic and testing capacity.

Delay in Diagnosis of Tuberculosis Among Patients Attending Different Dots Centres of Bharatpur Metropolitan City, Chitwan

“…An estimated 10.6 million people fell ill with Tuberculosis (TB) worldwide in 2021, which includes Six million men, 3.4 million women and 1.2 million children. 1 4.3 million Missing cases were estimated in the WHO South-East Asia Region (SEAR) in 2015, which accounted for 77% of this estimated gap globally. 2 Case notification rate (CNR) of all forms of TB is 112/100,000.…”

Frequency of Tuberculosis and its Outcomes After Anti-Tuberculosis Treatment According to Age and Gender

“…Traditionally, pulmonary tuberculosis is discovered when sick people visit hospitals for treatment. 1 In the past, public healthcare professionals have played a little part in encouraging the behavior of seeking health treatment for this stigmatized illness. Conversely, some policy experts think the healthcare system could become more aggressive in diagnosing tuberculosis (TB) to boost early diagnosis.…”

“…Conversely, some policy experts think the healthcare system could become more aggressive in diagnosing tuberculosis (TB) to boost early diagnosis. 1,2 An infectious and deadly disease, tuberculosis primarily affects developing nations. It is brought on by the Mycobacterium tuberculosis bacteria, which spreads through the air and affects the lungs as well as other organs and body parts of those who come into touch with infected people.…”

“…3 Although in Pakistan, the prevalence of tuberculosis is rising for a number of reasons, such as poverty, difficulty accessing TB treatment services, non-compliance with medication, cultural stigma, etc. 1 TB project leaders assert that a shortage of qualified human resources and a deficiency of tuberculosis treatments and diagnostic facilities are two main factors that compromise TB management. 1 Numerous low-income nations estimate twice as many instances of tuberculosis in males as in females, this disparity is typically attributed to biological and epidemiological factors in addition to social and cultural challenges to healthcare access.…”

“…1 TB project leaders assert that a shortage of qualified human resources and a deficiency of tuberculosis treatments and diagnostic facilities are two main factors that compromise TB management. 1 Numerous low-income nations estimate twice as many instances of tuberculosis in males as in females, this disparity is typically attributed to biological and epidemiological factors in addition to social and cultural challenges to healthcare access. 4 Despite the fact that older age seems to be an important predictor of both TB-specific deaths and non-TB-specific deaths when contrasted with some of those aged 25-44 years.…”