Engaging pharmacies in tuberculosis control: operational lessons from 19 case detection interventions in high-burden countries

• Published in: BMJ global health 2022-04, Vol.7 (4), p.e008661
• Main Authors: Bigio, Jacob, Aquilera Vasquez, Nathaly, Huria, Lavanya, Pande, Tripti, Creswell, Jacob, Ananthakrishnan, Ramya, Bimba, John S, Cuevas, Luis E, Vo, Luan, Bakker, Mirjam I, Rahman, Md. Toufiq, Pai, Madhukar
• Format: Article
• Language: English
• Subjects: Antibiotics; Antitubercular Agents - therapeutic use; Commentary; Developing countries; Disease control; Drug stores; Global health; Humans; LDCs; Low income groups; Monetary incentives; Pharmacies; Pharmacists; Public Health; Tuberculosis; Tuberculosis - diagnosis
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2022-008661

Establishing structured mechanisms for the referral of individuals with presumptive TB from pharmacies to private or national tuberculosis programme (NTP)-associated facilities for TB testing could help to identify some of the estimated 4.1 million individuals who develop TB each year but are not diagnosed or reported to NTPs. Since 2010, the Stop TB Partnership’s TB REACH initiative has funded 26 interventions in 15 low-income and middle-income countries which engaged pharmacies case detection interventions for TB. [...]the quality of TB care by pharmacies in low-income and middle-income countries (LMICs) is often low, with lack of TB knowledge among pharmacy staff, inappropriate sales of antibiotics and anti-TB medications, and lack of systems to facilitate referrals for TB testing.6–8 Most pharmacies are not linked to national tuberculosis programmes (NTPs) but establishing structured mechanisms for the referral of individuals with presumptive TB from pharmacies to private or NTP-associated facilities for testing could help to identify the estimated 4.1 million individuals who developed TB in 2020 but were not diagnosed and reported to NTPs.9 Between 2010 and June 2020, the Stop TB Partnership’s TB REACH initiative funded 26 interventions in 15 LMICs which engaged pharmacies to improve TB case detection, with the aim of demonstrating whether they are effective entry points to identify individuals with TB and whether they could subsequently be scaled up and transferred to a sustainable model either by other donor agencies or with monitoring and assistance from NTPs. Before agreeing to participate in projects, many pharmacy owners expressed concern about losing business if they were required to refer individuals with TB symptoms to the NTP or other providers. In many high-TB burden countries, undertrained or untrained staff work in unlicensed informal pharmacies or retail drug stores,6 and training such staff may require substantial investment of time and resources.