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. 2024 Mar 1;1(3):136-143.
doi: 10.5588/ijtldopen.23.0587. eCollection 2024 Mar.

2022 TB programme review in Pakistan: strengthening governance, with better patient diagnosis and treatment

M van den Boom  1 , K Bennani  1 , C Sismanidis  2 , C Gunneberg  2 , L Khawaja  3 , M A Safdar  3 , C Muhwa  4   5 , E Heldal  6 , D M Cirillo  7 , A W Khan  8 , R Fatima  8 , B J Khan  8 , S Tahseen  8 , M G ElMedrek  1 , Y Hutin  1 ; Pakistan Joint TB Program Review Mission
Affiliations

2022 TB programme review in Pakistan: strengthening governance, with better patient diagnosis and treatment

M van den Boom et al. IJTLD Open. .

Abstract
in English, French

Background: In Pakistan, 84% of healthcare is provided by the private sector. We conducted an epidemiological and programme review for TB to document progress and guide further efforts.

Methods: Surveillance and data systems were assessed before analysing epidemiological data. We reviewed the programme at federal, provincial and peripheral levels and compiled national data along with WHO estimates to describe the evolution of epidemiological and programme indicators.

Results: In 2021, of the estimated number of TB cases, 55% of overall cases and 18% of drug-resistant cases were diagnosed and treated respectively. The contribution of the private sector in case detection increased from 30% in 2017 to 40% by 2021. For newly diagnosed pulmonary TB cases, the overall proportion of confirmed cases was 52%. In 2021, testing for rifampicin resistance among confirmed cases was 66% for new and 84% for previously treated patients. The treatment success rate exceeded 90% for drug susceptible TB. The main challenges identified were a funding gap (60% in 2021-2023), fragmented electronic systems for data collection and suboptimal coordination among provinces.

Conclusions: The main challenges prevent further progress in controlling TB. By addressing these, Pakistan could improve coverage of interventions, including diagnosis and treatment. Bacteriological confirmation using recommended diagnostics also requires further optimisation.

Contexte: Au Pakistan, le secteur privé assure 84% des services de santé. Une étude épidémiologique et programmatique a été réalisée sur la TB afin de recueillir des informations sur les avancées réalisées et de guider les actions à venir.

Méthodes: Les systèmes de surveillance et de données ont été évalués préalablement à l'analyse des données épidémiologiques. Nous avons examiné le programme aux niveaux fédéral, provincial et local et compilé les données nationales ainsi que les estimations de l'OMS afin de décrire l'évolution des indicateurs épidémiologiques et du programme.

Résultats: En 2021, environ 55% de l’ensemble cas de TB et 18% des cas résistants aux médicaments ont été diagnostiqués et traités respectivement. La contribution du secteur privé dans la détection des cas est passée de 30% en 2017 à 40% en 2021. La proportion totale de cas confirmés pour les nouveaux diagnostics de TB pulmonaire s'élevait à 52%. En 2021, les tests de résistance à la rifampicine parmi les cas confirmés s’élevaient à 66% pour les nouveaux patients et de 84% pour les patients déjà traités. Le taux de réussite du traitement a dépassé 90% pour la TB sensible aux médicaments. Les défis majeurs comprennent un manque de financement (60% pour la période 2021–2023), des systèmes électroniques de collecte de données fragmentés et une coordination insuffisante entre les provinces.

Conclusions: Les défis majeurs entravent les avancées dans la lutte contre la TB. En les mettant en évidence, le Pakistan pourrait améliorer la portée des interventions, y compris le diagnostic et le traitement. Il est également essentiel d'optimiser la confirmation bactériologique en utilisant les diagnostics recommandés.

Keywords: National Tuberculosis Programme; drug resistance; prevention/control programme; tuberculosis.

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Conflict of interest statement

Conflicts of interest: none declared.

Figures

Figure 1.
Figure 1.
TB incidence disaggregated by HIV status and case notification rates, Pakistan, 2000–2021.
Figure 2.
Figure 2.
Number of TB case notifications by type, Pakistan, 2011–2022.
Figure 3.
Figure 3.
District-level TB notification rate/100,000,* all forms, 2021. *Numbers of districts in parentheses.
Figure 4.
Figure 4.
Contribution of the private sector to TB case notifications, Pakistan, 2017–2021.
Figure 5.
Figure 5.
Bacteriological confirmation of TB by type of private and public sector facilities, Pakistan, 2021. PPM4 = networks of hospitals of specific organisations or agencies; NGO = non-governmental organisation; GP = general physician.
See this image and copyright information in PMC

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