TB Platforms for Sustainable TB Detection, Care and Treatment

The Challenge

The Philippines ranks fourth among the 30 high-TB burden countries – with an estimated 599,000 TB cases – and seventh among the high multidrug-resistant-TB (MDR-TB or DR-TB) burden countries, according to the World Health Organization. With the introduction of mandatory private sector case notification, the Philippines has increased case notifications by 29 percent since 2017. While this is significant, the government estimates an additional 190,000 TB cases are missing and untreated.

Overview and Objectives

The TB Platforms Project strengthened TB interventions at the regional, local government, and community levels to increase TB case detection and treatment success rates. TB Platforms worked in three regions – National Capitol Region, Region 4A and Region 3 – and Marawi City. The project’s ongoing strategy involves:

Improving the reach of TB activities in multiple ways – such as ensuring that all patients visiting a health facility are screened for TB – engaging with private sector providers to offer screening and diagnostic services, increasing the use of digital platforms, and supporting approaches that will strengthen community-based TB service delivery, including social and behavior change communication strategies to reduce stigma and discrimination.

Increasing the success rate of TB treatments in part by applying URC’s patient-centered care framework through quality improvement (QI) teams and focusing QI strategies on comprehensively addressing patient needs. The project also is increasing use of treatment adherence tools, including mobile apps – especially in the private sector, supporting the decentralization of treatment, the acquisition of second-line drugs for an all-oral treatment regimen, and expanding health care packages to include DR-TB treatment.

Preventing TB transmission by expanding the routine screening of at-risk populations and contact investigations, developing better recording and reporting tools, strengthening infection prevention and control at institutions, and improving data management and infection prevention and control in health care facilities.

Increasing the sustainability of TB control efforts by strengthening the Department of Health’s capacities regarding procurement, supply chain management, monitoring and evaluation, human resources, and governance and financing capacity.

Achievements

Highlights

• TB treatment coverage rates increased from 60% in 2017 to 101% in 2023
• Treatment success rates (TSR) for drug-sensitive TB in the public sector have been maintained at 90%
• TSR for drug-resistant TB increased significantly from 56% in 2018 to 84% by the end of 2023
• Targets for childhood TB (88%) and private sector notifications (112%) were achieved

TB Platforms designed and pretested a social behavior change strategy, called Tibay ng Dibdib – literally, “chest strong,” which aimed to improve knowledge and risk perception of TB among Filipinos. In Marawi, this concept was scaled up with buy-in from the regional centers for health development. For example, the project developed a children’s story and coloring books entitled Tibay ng Dibdib that explain TB and how it is cured. More than 4,000 story and 6,000 coloring books have been distributed. The Department of Education in Quezon city also adopted the story book in their elementary school health education program.

TB Platforms supported the adoption by local government units of TB ordinances that allocate resources and funding for local TB responses. In Metro Manila, Pasig, Paranaque, Manila, and Navotas were the first cities to develop and pass TB ordinances. In all, TB Platforms has supported local investment plans for health in 52 local government units to allocate a total of 65M PHP (US$1,144,033) to implement local TB activities.

The project also developed a mentoring program called COME ALIVE (Communicate and Mentor Effectively through Ask-Listen-Inform-Verify-Encourage). The program engaged community and Barangay health workers (BHWs) to improve TB awareness in communities. More than 1,600 BHWs were mentored using the COME ALIVE approach to empower their communities to improve their health-seeking behavior. With these mentored BHWs and other community health volunteers, more than 523,000 high-risk individuals were screened, 13,000 household contacts were investigated, and more than 27,000 individuals were X-ray screened, with 735 TB cases diagnosed.

Another key project strategy is the Finding TB Actively, Separating safely, and Treating effectively (FAST) approach, which includes actively seeking and identifying hospital visitors, patients, and health care workers with TB symptoms, testing them, and educating them about TB. TB Platforms developed and has scaled up FAST to 184 health facilities as an infection prevention approach to reduce TB transmission in health care facilities, screening 4.3 million people, diagnosing 135,000 TB cases, and 2,700 MDR-TB cases since 2019.

In all, TB Platforms has helped screen 6,524,904 people for TB through active case finding or FAST, with 109,754 people testing positive for TB and being put on treatment. Also, the activity – through its range of interventions – helped increase the drug resistant-TB treatment success rate from 56% in 2017 to 81% in 2023.