You are here:

Improving retention during TB preventive treatment through person-centred care in South East Asia

Published on


The Union is leading a study to improve the retention of people during TB preventive treatment in India, Bhutan, Indonesia, Nepal and Sri Lanka.

The Comprehensive Strategy for Retention in TB Infection Cascade of Care (CRITIC) study will determine the effectiveness of a person-centred strategy, compared to current practices in South East Asia.

The strategy aims to ensure 80% retention of eligible people in each step of the TB preventive care journey among high-risk groups, by reducing delays in testing and treatment initiation and removing barriers. For example, minimising time and cost burden on people with TB and their families, carrying out screening for TB disease and testing for TB infection in parallel, and coordinating multiple care activities during the same hospital visits.

Studies have shown that this approach is useful for household contact investigation, is cost-effective and conducive to a greater yield and retention on treatment.

The study team expect to:

  • Screen 35,000 household contacts, risk groups and prison inmates for TB
  • Initiate at least 80% of those eligible on TB preventive treatment (TPT)
  • Ensure that 80% of those people complete the treatment

The approach is an adaptation of the World Health Organization’s simplified four-step person-centred TB infection cascade of care for implementation of TB screening and TPT. It includes identification of target populations, same-day screening for TB infection and disease, testing for TB infection, enhanced counselling for TPT initiation, shorter TPT regimens, and follow-up until treatment completion.

The Union will also look to introduce:

  • TB screening at the point of care using handheld X-ray devices
  • A Mycobacterium TB specific skin test 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.

Dr Bharati Kalottee, CRITIC study lead at The Union, said: “In order to control TB, it is essential to screen people who are 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 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 Bill and Melinda Gates Foundation.