Senior epidemiologist Mirjam Bakker was in Pakistan for the start of a new research project and visited a chest camp. She sent us a dispatch from Islamabad.

From 26 to 31 January I travelled to Islamabad in Pakistan to prepare and join the 2-day kick-off and protocol development workshop of an exciting new research project with the objective to develop innovative active case finding (ACF) approaches to optimise community screening for tuberculosis (TB) and to evaluate the cost-effectiveness of these new approaches. 

TB control still faces many challenges in Pakistan. In 2023, the country had an estimated incidence rate of 277 cases per 100,000 people, ranking 26th globally. However, due to its large population, Pakistan ranked 5th in absolute TB cases, with an estimated 686,000 people affected. Of these, only 69% were treated, leaving a substantial number of patients untreated, contributing to further spreading of the disease. 

The research is led by Mercy Corps Pakistan, funded by the Gates Foundation and Stop TB Partnership, with the Center for Global Public Health-Pakistan (CGPH-Pakistan) and KIT Institute as research partners, with involvement of Ente Rood and Christina Mergenthaler as well. Stakeholders are the National and provincial TB Control Programmes, The Global Fund and implementing partners. 

The research consists of multiple phases, where in the first year the new tools will be compared to the existing tools in terms of costs and performance and in the second year the cost-effectiveness of two new strategies will be measured against the current approach in a so-called cluster randomised cross-over trial. 

Pictures: Kick-off Meeting & Protocol Development Workshop Day

During the workshop partners and stakeholders discussed which tools to include in the research, operational aspects of the new tools, study design and dissemination strategies. I was happy to participate as a speaker, group discussion facilitator and panel member. What I really appreciated was the active engagement of all participants during the workshop.

Before the workshop, I had the insightful opportunity to visit a “chest camp” (the local name for an ACF event) in a community, which was about a 2hrs drive from Islamabad. In the week leading up to the event, the community was made aware of the chest camp and people were motivated and encouraged to attend – especially individuals with coughs. People attending the chest camp followed a standard route: from registration to chest x-ray screening for abnormalities in the lungs using CAD4TB, to sputum testing using GeneXpert for those with abnormalities, and as a last step, linkage to treatment in case of TB diagnoses. The chest X-rays and sputum testing were conducted in a van positioned just outside the community, while tents were put up to provide waiting spaces for men and women, and for a medical doctor to see all participants and also treat other (small) health issues. Very interesting to finally see such a chest camp event in practice. 

Pictures: Visiting a chest camp. Credit: Mirjam Bakker

Since 2019, KIT has supported the NTP and Mercy Corps in deciding where to organise the chest camps. Ideally, chest camps are organised in communities with many people with untreated TB, the challenge lies in knowing where these communities are. Results of past chest camps together with other information such as population density, access to TB care, poverty levels, and people with TB on treatment, can support this choice. With the current USAID stop-work orders, heavily affecting TB programmes through budget cuts, this research on making ACF more cost-efficient becomes even more important.