Tuberculosis (TB) remains a significant death causes in India. The country has the highest rates and burden of both tuberculosis and multidrug-resistant (MDR) TB. The cascade of care shows that enduring behavioral and structural challenges continue to erode patient retention at every stage of care.
Engaging diverse stakeholders distributed along the cascade requires an understanding of the patient context. Yet, national protocols on transformational initiatives are often standardized and do not acknowledge the heterogeneity in local health systems, resource availability, and institutional capacity to adapt and implement change. As a result, each stakeholder’s social, emotional, cultural, and other behavioral factors conditioning choices are also not considered. Combined, these factors pose significant barriers to creating meaningful behavior change at the population-level.
Care that fits people’s lives
We are working with the World Health Partners in collaboration with Dr. Megan Murray to eradicate TB by conducting ethnographic studies and designing prototypes in two to four districts of two states in India. We intend to identify behavioral patterns related to family habits, emotions, logistical challenges, and other invisible determinants that can cause many patients to drop out during the care cascade. This project has been funded by the USAID.
The project’s overall goal is to strengthen district health systems to reduce gaps in diagnosis, treatment, and recurrence-free survival to achieve high quality and equitable care. We will work together to prototype interventions and demonstrate models that can significantly reduce care cascade gaps while simultaneously strengthening health systems and improving the quality of life across all stakeholders involved. Models that optimize care delivery across the entire cascade are highly likely to translate to successful treatment outcomes and, when scaled, have a substantial impact on eradicating TB.