Tuberculosis and PSI

Jennie Quick, PSI

April 29, 2010

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Overview

• Who is PSI?

• PSI’s approach to public health

• What is social franchising?

• PSI and TB

• Next steps

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Who is PSI?

• International non-profit• Incorporated in 1970• More than 60 country

offices• Based in Washington• World leader in social

marketing and behavior change communication

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Key Health Areas

• HIV/STI prevention• HIV Counseling and Testing (CT)• Reproductive Health• Malaria• Diarrheal Disease• Pneumonia• Tuberculosis

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PSI and TB

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What is social franchising?

Franchise Responsibility:

• Training

• Quality Assurance

• Monitoring and Evaluation

• Drugs, Supplies and Consumables (as appropriate)

• Communication, Branding and Demand Creation

Franchisee Responsibility:

• Quality Service Provision (according to standards and protocols)

• Implement Recommendations

• Recording and Reporting

• Participate in Network Activities

Once established, a successful social franchise can be rapidly scaled-up with limited cost and expanded to include other health

services.

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Sun Quality Health - Myanmar

• Launched in 2004• Passive case-finding model • Franchise of General Practitioners

in the private sector• Providers trained in TB symptomatic screening, diagnosis and treatment • Refer suspected TB cases to qualified labs • Treatment supporters provide follow-up to encourage adherence, trace

clients who default on treatment and conduct contact tracing • PSI officers monitor quality assurance regularly • Demand creation through IPC and mass media

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Results from Myanmar

• 150 townships in 11 states • 691 providers, 145 labs• 116,849 clients tested for TB• 53,890 registered TB cases• 27,711 Category 1 cases• 84% treatment success rate• 10% contribution to national case

detection rate• >55% of patients are from the

lowest two socio-economic groups

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GreenStar - Pakistan

• Launched in 2005• Active case-finding by Community Health Officers• Door-to-door screening in high burden neighborhoods • Community-events for sputum collection• Private general practitioners trained in symptomatic screening,

diagnosis and treatment • Referrals provided to qualified labs • Treatment supporters to encourage adherence, trace patients

who default and to conduct contact tracing• QA visits from GreenStar project officers

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Pakistan: GreenStar and TB

• 1,080 providers, 49 labs• 36,277 community-based

treatment supporters trained • 2,100,000 people reached• 40,419 registered TB cases• 89% treatment success rate• 33-51% contribution to case

detection rate in areas where it operates

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TB Communications

• Where?– Central Asia, India,

Kenya, Laos, Myanmar and Romania

• What?– TB (awareness,

treatment seeking, adherence, etc.)

– TB/HIV– Stigma

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PSI and TB/HIV

• Non-medical TB screening of HCT clients and referrals to laboratory diagnosis– India, Mozambique,

Myanmar, South Africa, Zambia, Zimbabwe

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South Africa: HIV/TB Integration

• Launched in 2006• Mobile HIV counseling and testing

(CT) for individuals from out-patient departments/TB wards

• HIV-positive individuals referred back to clinic

• July 2006 - Sept 2009, >7,000 patients tested for HIV

• Among TB patients, 90% tested HIV-positive

• 80% of referrals tracked successfully

• Telephone tracking ensures patients use referrals

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Zimbabwe: HIV/TB Integration

• HCT Clinics perform symptomatic screening

• Recently, clinics began offering sputum microscopy onsite

• Individuals who are diagnosed with TB are referred to public health facilities for treatment

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Next Steps

• Continued TB service delivery through existing franchises– Scale-up of existing programs – Launch of new networks

• Support NTCPs and other partners in delivering evidence-based communications for TB and TB/HIV

• Expand TB services offered within HCT clinics – including lab diagnostic services

• Strengthen TB screening among PLWH by scaling up screening through HCT

• Increase support to NTCPs to provide provider-initiated HIV counseling and testing to all TB suspects and patients

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Thank you!

For more information on PSI and TB

please contact:

Megan Elliott

melliott@psi.org