The patient-initiated pathway to TB diagnosis can be enhanced by:
- improving access to care, including reducing the direct and indirect costs to patients associated with seeking care and addressing the specific needs of vulnerable groups by strengthening primary health-care services, extending diagnostic and testing services and providing social protection schemes where possible and necessary.
- improving the acceptability of care, by ensuring privacy and providing fast-tracking through outpatient departments and faster services to reduce waiting times and to ensure that daily wageearners do not lose income. Incorporating “care” aspects, by including emotional care in addition to diagnosis and treatment in training curricula help to ensure empathetic, compassionate and patient-centred care (9).
- community engagement and demand generation, by education and awareness campaigns (including on exposure and risk) for the general public and in communities that are at higher risk of TB to increase the likelihood that those who have been exposed and/or have TB disease will seek care at facilities with the capacity to diagnose and treat TB.
- training and capacity-building of health-care workers, by providing additional training and equipping all health-care workers in the health system, in both the public and the private sectors, in primary care, at entry points to health care and lay community workers and volunteers (10) to increase the likelihood that individuals with symptoms of TB who seek care are recognized and referred for appropriate evaluation and care.
- reassessing the definition of a person with possible TB, by broadening the indications for diagnostic testing for TB, in accordance with the local epidemiology of the disease and the epidemiology of the most common risk factors for TB to help ensure that the appropriate people are targeted for evaluation.
- improving access to testing and diagnostics, by increasing the capacity of mWRDs, ensuring sufficient laboratory requirements, including human resources, improving links between the private and public sectors and improving the system of reporting results from the laboratory to the clinician.
- making any other changes to current approach to passive case detection, as such changes may result in more patients identified in facilities. Greater use of CXR, mWRDs and other accurate tools for diagnosing TB may increase the number of people with TB detected.
Additional approaches to increasing the capacity for TB care and prevention include:
- improving the integrated management of respiratory conditions in primary health care (11);
- scaling up mWRD testing (e.g. Xpert MTB/RIF, Truenat MTB and MTB-RIF Dx) (12, 13);
- scaling up sputum collection and transport systems;
- improving the diagnosis of bacteriologically negative TB, extrapulmonary TB and TB in children;
- providing access to CXR services and CAD; and
- improving referrals and notifications by all care providers (10).