ReliefWeb

By: Tripti Pande, Nathaly Aguilera Vasquez, Danielle Cazabon, Jacob Creswell, Miranda Brouwer, Oriol Ramis, Robert Hartley Stevens, Ramya Ananthakrishnan, Shahina Qayyum, Chukwuka Alphonsus, Charity Oga-Omenka, Vaidehi Nafade, Paulami Sen, Madhukar Pai

Introduction

In 2019, 10.0 million people developed tuberculosis (TB) yet 2.9 million were not notified to National TB programmes (NTPs).1 This is largely due to limited accessibility to healthcare services, underdeveloped health reporting systems, insufficient human resources and poor linkages between private providers and national authorities.2 There are various global initiatives to address this challenge, including the Find.Treat.All #EndTB initiative and the End TB strategy which aims to reduce TB incidence by 90% between 2015 and 2035.3

To support innovative programmes, approaches and technologies aiming to increase the number of people detected with TB in low-and-middle income countries (LMICs), the TB REACH initiative was launched in 2010. It is led by the Stop TB Partnership and primarily funded by the Government of Canada.4 Active case finding (ACF) interventions are the most commonly funded TB REACH interventions and refer to screening that occurs outside of the healthcare system where individuals with TB-like symptoms are identified and referred for TB diagnosis. This differs from common practices where the patient seeks diagnosis at a health facility (ie, passive case finding).5

While there have been various evaluations on the effectiveness of the ACF interventions in many LMICs such as India, Nigeria and Cameroon,6–8 lessons learnt from implementation experiences are often constrained to internal meetings or annual reports. This limits sharing of valuable lessons learnt across multiple settings and among implementors which could be leveraged in the planning and implementation of new ACF interventions. With the push to find the missing millions, we discussed lessons learnt with 10 implementors funded by the TB REACH initiative, each targeting different populations (ie, children, transgender communities, rural communities) across a wide range of settings and countries (table 1). Further, to provide a holistic view, we also incorporated the perspectives of monitoring and evaluation (M&E) consultants and members of the TB REACH secretariat who are key stakeholders in the TB REACH initiative.