In December 2023, The Union reported early evidence that the adapted 7-1-7 timeliness metric could inject much-needed urgency and energy into the process of household contact screening and tuberculosis preventive therapy (TPT).
Three original studies conducted and published by the Centre for Operational Research and its partners assessed household contact screening and management in the private sector in southern India, within the National TB Programme in Kenya and in tertiary health care facilities in Pakistan.
The fourth and final original study in this series has now been published in BMJ Open (https://bmjopen.bmj.com/content/15/11/e097935.full).
This study was conducted within the routine health services of India’s National TB Programme across the states of Bihar, Chhattisgarh and Odisha, examining the role of “TB Champions”, trained TB survivors who volunteer their time to support community-level activities. Their responsibilities vary by state but commonly include active case finding, household contact screening and support for treatment adherence.
For this project TB Champions received additional training in household contact management aligned with the 7-1-7 timeliness framework and were trained to collect time-based data on mobile devices.
The findings were notable. Overall, 89% of household contacts were line-listed within seven days of the index pulmonary TB patient beginning treatment (the first 7), and 90% had their symptom-screening outcomes recorded within one day of being line listed (the 1). In addition, 42% completed early response actions of starting TB treatment, beginning TPT or making a firm decision for no action within 7 days of outcome ascertainment (second 7).
TB Champions reported that the timeliness metrics were practical and helpful, offering a clear structure for each step of household contact management and supporting a more systematic, efficient workflow.
The World Health Organization endorses the involvement of TB survivors for the provision of effective TB care and prevention. In many resource-limited settings, programme staff are already stretched thin across multiple responsibilities ranging from patient detection and diagnosis to treatment and monitoring, leaving limited capacity for systematic household contact screening.
The study findings indicate that TB survivors can play a meaningful role in filling this gap and can do so within the 7-1-7 timeliness framework.
Prof Anthony Harries, Senior Advisor at The Union, said: “TB survivors often have credibility and trust within the community, and this can be leveraged to provide line-listing, screening and response actions for household contacts. Training and using TB survivors for TB response activities is a low-cost and sustainable strategy which needs to be more widely used and scaled up.”
Read the final study here.