A Public-Private Mix Intervention To Enhance Tuberculosis Case Finding In Resource Constrained Industrial Settings

Background: The disease Tuberculosis tends to concentrate among the poorest, the marginalized and the most vulnerable populations such as those residing in the slums, migrant labour class, and industrial workers. Being one of the top ten causes of deaths worldwide, Tuberculosis is the biggest public health challenge of the present times. Continuous disease surveillance and monitoring comprehensively help in the approach for Tuberculosis management. Under one such operational research, assessing the treatment seeking patients of a Directly Observed Treatment Centre of a hospital of an industrially dominated area, it was revealed that 41 patient were diagnosed and initiated on TB treatment by Designated Microscopy Centre (DMC), the Tuberculosis diagnostic laboratory of another Health Centre, 5 kilometers apart. In fact active case finding was zero at this hospital. Distant DMC was significant impediment for follow up sputum microscopy and contact screening. As a result many tubercular patients went missing and the public health system had difficulty in capturing these cases. This was proving a major hindrance in tuberculosis management in this industrial township. Objectives: (1) To enhance active case finding in the hospital (2) To enhance active and passive case finding in the community. Methods: A DMC in the public health hospital was started, Medical staff was sensitized and community mobilization initiated by roping in an NGO in “Sputum pick up and transport scheme” of the Public Sector, in 7 slum areas, for prompt diagnosis of TB. Results: Active and passive case finding rose from zero to 52 and 20 respectively in the year 2015 and it was 204 and 56 cases respectively in 2016. Slide positivity rate was 8.2% in 2015 with 6 New Smear Positive cases and two positive follow up cases whereas it was 8.8% in 2016 with 18 new and 16 follow up positive cases. 15 out of 179 Presumptive cases found by active search, four suspected follow up cases and 6 out of 56 Passive cases were positive for TB. Conclusions: Public private partnership increases active and passive case finding in industrially dominated area by minimizing the challenges of loss of working hours, absenteeism from work and cost of travelling. The strengths of the private and public sector thus can go hand in hand for tacking the constraints of the resources of an area.