Kirubi Beatrice, Eman Kinz Ul, Lodhi Usman R, Fatima Razia K, Kazi Ghulam Nabi, Tahmeena Tahmeena, Shah Syed Karam, Creswell Jacob
Innovations & Grants, Stop TB Partnership, Global Health Campus - Chemin du Pommier 40, Le Grand-Saconnex, 1218, Geneva, Switzerland.
Dopasi Foundation, Islamabad, Pakistan.
BMC Health Serv Res. 2025 Jan 10;25(1):53. doi: 10.1186/s12913-024-12202-6.
In Pakistan, almost one-third of people who develop tuberculosis (TB) are missed by the National TB Program (NTP). A considerable number of people with TB receive treatment in the private sector but remain unnotified. This study documents the outcomes of an intervention to identify people with TB through private pharmacy engagement, building on mapping TB medicine sales in Punjab Province.
A comprehensive intervention was carried out in four districts of Punjab with high anti-TB drug sales, comprising a policy change requiring mandatory notification of TB medication sales, mapping and engaging pharmacies selling anti-TB drugs, reporting through a novel 'eTB' mobile application and providing support via a call center. We collected both historical and prospective TB notification data from the intervention and control districts. The primary outcome was the change in TB notifications during the intervention period compared with historical and control notifications.
Over the 12-month intervention period, 15,669 people with TB were reported from 2,943 pharmacies in four districts. Among the people identified, 88% were male (n = 13,673), 95% had pulmonary disease (n = 14,969), and 4,256 (27%) were bacteriologically confirmed. Chain pharmacies (n = 14) contributed to 39% of the yield. TB notifications increased by 17,462 (+ 34%) over the baseline period compared with an 8% increase in the control districts. The number of bacteriologically confirmed notifications increased by 32% compared with 16% in the control districts. The proportion of bacteriological confirmation was similar before and during the intervention.
The results of the largest TB intervention with pharmacies globally showed incredible potential to link people with TB who are receiving care in the private sector. Mapping TB medicine sales in the private sector with tailored interventions can contribute to closing the gap in notifications where anti-TB drug sales in the private sector are prevalent.
在巴基斯坦，国家结核病规划（NTP）遗漏了近三分之一的结核病患者。相当一部分结核病患者在私立部门接受治疗，但未被报告。本研究记录了一项通过与私立药店合作来识别结核病患者的干预措施的成果，该干预措施基于对旁遮普省结核病药物销售情况的摸底。
在旁遮普省抗结核药物销售量高的四个地区开展了一项全面干预措施，包括一项政策变更，要求强制报告结核病药物销售情况，对销售抗结核药物的药店进行摸底并与之合作，通过一款新型的“电子结核病”移动应用程序进行报告，并通过呼叫中心提供支持。我们收集了干预地区和对照地区的历史及前瞻性结核病报告数据。主要结果是干预期间结核病报告数量与历史报告数量及对照地区报告数量相比的变化情况。
在为期12个月的干预期间，四个地区的2943家药店报告了15669例结核病患者。在识别出的患者中，88%为男性（n = 13673），95%患有肺部疾病（n = 14969），4256例（27%）经细菌学确诊。连锁药店（n = 14）贡献了39%的报告量。与基线期相比，干预期间结核病报告数量增加了17462例（+34%），而对照地区增加了8%。细菌学确诊报告数量增加了32%，而对照地区增加了16%。干预前后细菌学确诊比例相似。
全球最大规模的与药店合作的结核病干预措施结果显示，在联系在私立部门接受治疗的结核病患者方面具有巨大潜力。通过量身定制的干预措施对私立部门的结核病药物销售情况进行摸底，有助于缩小在私立部门抗结核药物销售普遍的地区报告方面的差距。
