Finding Tuberculosis Hotspots in Pakistan

With funding from the KIT Knowledge Investment Fund (KIF), our epidemiologists have developed a novel approach to identifying Pakistan communities with a high likelihood of having people with undiagnosed tuberculosis (TB).

TB’s lengthy and unpredictable incubation period makes detection difficult using conventional measures and is one of the reasons why the disease has been so successful in remaining hidden and widely distributed throughout the world.

“Pakistan has a very high TB burden, and up to 250,000 TB cases are missed or unnotified by screening systems,” explains Abdullah Latif, Data Manager for Pakistan’s National AIDS, TB & Malaria Control Programme. “Active case finding…[proactively screening for TB]…can help find these missed cases, but these interventions are expensive and time intensive.”

This means that for practical reasons, not all communities can be screened. The challenge, therefore, is to determine where and among which populations to look.

KIT’s electronic Case-Based Surveillance (eCBS) project, a collaboration with the Pakistan TB Control Programme, MercyCorps and EPCON, provides an innovative solution to this challenge. It uses real-time analysis of both TB chest camp screening data and a repository of TB, demographic and epidemiological data linked to geographic regions in Pakistan to make predictions of communities where undetected TB cases are likely to be high.

The project also improves efficiency by working with MercyCorps to shift from paper to electronic data collection. This is vital, as the project is predicated on using real-time data to help steer subsequent chest camp locations and validate or correct the model’s predictions. Digital data from community-based chest camps are now streaming into the eCBS server in real-time, and a visualization dashboard is providing the Pakistan TB Control Program and MercyCorps with new information to guide their TB screening efforts.

This methodology is now being piloted in Punjab province, and the first two months of using recommended screening locations have had very encouraging results, finding a higher than average number of infectious people in the community.

In the coming months, with the support of funding from international donors, the eCBS project will not only support MercyCorps in the expansion of data digitization in case finding efforts into two new provinces of Pakistan, but will gradually scale-up the number of screening locations that it recommends each month.

The ultimate goal is to give complete and autonomous control of eCBS to Pakistan’s TB Control Programme and participating NGOs like MercyCorps.