CHICAGO – To find the missing tuberculosis cases that go unreported each year, national TB programs will have to reach out to the places where the most people seek care, researchers said here. And that’s not in public hospitals or clinics where capacities to respond to TB already exist, but in the private sector in all the highest TB-burden countries. While the first destination for significant numbers of patients sick with tuberculosis, the private sector – which includes traditional and faith healers along with licensed medical professionals – is also the where most TB cases go undetected.
That will have to change if member states are to achieve the detection and treatment targets in the political declaration agreed to in the September 2018 UN High Level Meeting on ending tuberculosis, Christy Hanson of the Bill & Melinda Gates Foundation said.
“Fewer than 30 percent of people with TB symptoms who seek care will encounter diagnostic technology,” Hanson said.
Of the four million cases of TB that go unreported every year, 60 percent occur in just seven countries, Dr. Madhukar Pai of McGIll University said, and in those countries between 65 and 85 percent of patients initially seeking-seeking care come to those private practitioners, who report only 19 percent of TB notifications.
In the seven highest TB burden countries – Bangladesh, India, Indonesia, Myanmar, Nigeria, Philippines and Pakistan – TB control programs often direct private practitioners to refer suspected TB cases to the public sector. Instead, TB control programs need to strengthen private providers’ ability to find and treat patients.
“The public health system picks up TB way better than the private sector because they have a TB protocol,” Dr. Pai said. That can change, however, by directing resources to the private sector. When, in a program in India, private practitioners were provided with training and GeneXpert technology to rapidly diagnose both drug sensitive and drug resistant forms of TB, medicines and other services, TB case notification jumped, Dr. Pai said.
In a place like Mumbai, the Indian city with the highest TB burden and where a study found that less than 17 percent of private providers correctly managed suspected TB cases and sent patients home with an average of 4.5 antibiotics, steroids, or other medicines they didn’t need, training private providers is the “key to winning over patients,” Dr. Pai said.
“We can’t reach all people by only focusing on the public sector,” Hanson said. “We need to change the system, not expect patient behavior to change.”