Assessment of TB-HIV Linkage under Challenge TB and JEET: Estimation of costs and study of patient screening
Assessment of TB-HIV Linkage under Challenge TB and JEET: Estimation of costs and study of patient screening
Year: March 2019
Collaborator: PATH Foundation
Team: Sarang Deo, Hemanshu Das, Harsh Parekh
Background
Tuberculosis (TB) co-infections cause 25% percent of the mortalities among people living with HIV (PLHIV). To address high TB rates in PLHIV, PATH used the BMGF-funded Universal Access to TB Care (UATBC) model in Mumbai and piloted HIV screening for TB patients to reduce diagnosis delays and ensure early treatment linkage. Patients reactive in private sector tests received assisted follow-ups to public HIV care centres via link counsellors.
As the management transitioned from PATH to the Municipal Corporation of Greater Mumbai (MCGM) under the Joint Effort for Elimination of TB (JEET) program, funded by Challenge TB (PEPFAR). The diagnosis approach shifted from paper voucher-based free private sector tests to a mix of free and subsidized public-private models. There were plans to scale these TB-HIV models to other JEET cities based on needs. Early data highlighted insufficient funding, affecting outcomes. Moreover, coordination between Revised National Tuberculosis Control Programme (RNTCP) and National AIDS Control Organisation (NACO) requires review to improve patient pathways.
About the Study
The study aimed to build scientific frameworks for understanding the:
- Resource needs (costing and workload assessment) for implementing HIV-TB linkage under a RNTCP funded district with fully functional TB Public Private Mix scheme.
- Effect of change in financing model for patient screening and linkage from private to public sector.
Methodology
Semi-structured interviews of the involved stakeholders, including NGO staff and program managers helped understand the roles and activities in the service delivery model. The interviews allowed an assessment of the workload associated with the scope (frequency, duration, quality) of the activities. The workload assessment along with an understanding of the activities undertaken was utilised for the costing exercise.
Outcome
The project developed a costing tool to help government bodies and NGOs to determine the cost of running a PPSA agency in a district. Nuances of the study can be taken up by the Revised National TB Control Programme (RNTCP) to invite implementation agencies in various districts of India.