A multi-country study aiming to improve the retention of people in different phases of care for TB prevention across South-East Asia is underway.
The study is being undertaken in selected districts of India, Bhutan, Indonesia, Nepal and Sri Lanka. It is led by the Indian Council of Medical Research, South-East Asia Region Regional Research Platform, with The Union as the implementing partner, and supported by the Gates Foundation.
The Comprehensive Strategy for Retention in TB Infection Cascade of Care (CRITIC) Project will determine the effectiveness of a person-centred approach to implementing TB screening and TB preventive treatment (TPT).
The goal is to ensure 80% retention of people in each step of the TB preventive care journey, by reducing delays in testing and treatment initiation and removing barriers, through:
- Minimising time and cost burden on people on TPT and their families
- Carrying out screening for TB disease and testing for TB infection in parallel
- Coordinating multiple care activities during the same hospital visits
Dr Bharati Kalottee, CRITIC Study lead at The Union, said: “In order to control TB, it is essential to screen people who are close contacts of people with TB and high-risk groups, like prison inmates. It is essential to review current approaches and design new strategies that best meet the needs of the people with TB and their contacts and are feasible within the local context.
“The CRITIC Study will help identify practical and programmatic challenges that limit access to TB infection testing and uptake of TPT and take steps to resolve them.”
The study has been rolled out in India, Indonesia, Nepal and Sri Lanka, but there have been some delays in Bhutan.
Nidhi Bansal, Country Director for The Union India Office, stated: “Such South-South collaboration is vital to facilitate the proactive knowledge exchange between countries with similar challenges. Our ability to work together is even more important during these uncertain times.”
To date, over 1,200 household contacts of people with TB have been screened with chest X-rays and tuberculin skin tests, and over 240 people have been initiated on TPT. The study has seen a 96% treatment completion rate with 3HP regimen (consisting of 12 once-weekly doses of isoniazid and rifapentine), as 26 of 27 people have successfully completed treatment.
The study team will look to introduce:
- TB screening at the point of care using handheld X-ray devices
- A Mycobacterium TB specific skin test (Cy-TB) with high sensitivity and specificity for the detection of TB infection
- Effective counselling for TPT initiation and completion along with digital adherence technology
- A user-friendly data recording system for timely action to support people throughout their care journey
Qualitative research is also part of the study, with the secondary objective to:
- Identify the enablers and barriers for the implementation of the comprehensive intervention strategy and for ensuring 80% retention in TB infection cascade of care among the high-risk groups from both the provider and participant perspectives.
- Estimate the cost effectiveness of the strategy in improving the TB infection cascade of care in high-risk groups when compared to current practices in the South-East Asia Region countries.