Investigator(s)
| Submitter |
Karchung Tshering Royal Centers for Disease Control, Ministry of Health Karchung Tshering 
|
| Principal Investigator |
Karchung Tshering Royal Centers for Disease Control, Ministry of Health Karchung Tshering
|
| Co-Investigator(s) |
Yeshi Om Tshering Lungtenphu Hospital Yeshi Om Tshering
|
| Co-Investigator(s) |
Phurpa Tenzin Ministry of Health Phurpa Tenzin
|
| Co-Investigator(s) |
Phurpa Wangdi Jigme Dorjii Wangchuck National Referral Hospital Phurpa Wangdi
|
| Co-Investigator(s) |
Sonam Tshoki Lhamu Royal Centers for Disease Control Sonam Tshoki Lhamu
|
| Co-Investigator(s) |
Gyembo Dorji Jigme Dorjii Wangchuck National Referral Hospital Gyembo Dorji
|
| Co-Investigator(s) |
Tandin Zangpo Gidakom Hospital Tandin Zangpo
|
| Co-Investigator(s) |
Tsheltrim Dema Ministry of Health Tsheltrim Dema
|
Title(s) and abstract
| Scientific title | Comprehensive intervention strategy to improve retention in TB infection cascade of care in high-risk groups through a person-centered approach in the SEAR countries |
| Public title | COmprehensive strategy for retention in TB infection cascade of care (CRITIC study) |
| Background | The National TB Control Program (NTCP) under the Ministry of Health (MoH) was started in 1976 and the TB control interventions in Bhutan were intensified when the World Health Organization (WHO) declared TB as a global health emergency in 1993. Since then, considerable progress has been made in TB diagnostics, care and treatment in the country. Bhutan achieved MDG goal of halving TB incidence and mortality as compared to 1990 targets. In Bhutan, the tuberculosis incidence (per 100 000 population) has improved by 75 cases per 100 000 from 239 [183 - 302] in 2000 to 164 [126 - 208] in 2023 (Global TB Report 2024, WHO). The treatment success rate for all forms of TB was 90 % in 2022 and 96% for Multi-Drug Resistance TB (MDR-TB) for the 2021 cohort, which is comparatively higher than many countries in the SEA region. However, with a higher case detection gap and increasing trend of MDR-TB with higher prevalence among the new cases, controlling TB continues to be a major public health concern in Bhutan. The MDR-TB prevalence among the new TB patients stands at 12% and 14% among the previously treated cases in 2023. Moreover, the complexities around the treatment and management of MDR-TB is a growing concern for Bhutan. In line with the Global End TB strategy, Bhutan aims to reduce DS-TB and DR-TB burden until it no longer poses a public health problem in the country. The Bhutan TB NSP III (2024-2028) has been developed in accordance to WHO guidance with goal to reduce the incidence of TB by 10% from 2027 onwards. One of the objectives of the NSP III focuses to impact the TB epidemic in Bhutan by increasing the number of individuals with TB infections undergoing TB Preventive Treatment (TPT) of 50% per year between 2024 and 2028. |
| Objectives | The overall aim is to develop an acceptable, feasible, cost-effective and sustainable comprehensive intervention strategy based on the WHO four-step person centered TB infection cascade of care to improve retention among high-risk groups in the SEAR countries. Primary objective: • To determine the effectiveness of a comprehensive intervention strategy in ensuring 80% retention in each step of the TB infection cascade of care among the high-risk groups when compared to current practices under the programme setting in the selected district. Secondary objectives: • To identify the enablers and barriers for the implementation of the comprehensive intervention strategy and for ensuring 80% retention in TB infection cascade of care among the high-risk groups from both the provider and participant perspectives. • To estimate the cost effectiveness of the comprehensive intervention strategy in improving the TB infection cascade of care in high-risk groups when compared to current practices under the programme setting in the selected district. |
| Study Methods | Study design: Implementation research study to assess the effectiveness of comprehensive intervention strategy for improving the retention in the TB infection cascade of care among high-risk groups. A mixed method approach will be used to collect data for pre and post intervention comparison. Study setting : The SEAR member states willing to participate in this study are Bhutan, India, Indonesia, Nepal, and Sri Lanka. In each of these countries it is planned to be conducted at one selected district/province. Proposed site in Bhutan includes 20 districts (32 TB reporting centers). |
| Expected outcomes and use of results | 1.The proportion of participants retained in each step of the TB infection cascade of care compared to current practices under the programme setting in the selected district. (Target is 80% at each step of the TB infection cascade of care) 2. The implementation outcomes in terms of the following will be obtained (in accordance with the domains of the RE-AIM evaluation framework31) Acceptability – the perception among the stakeholders and the providers about the strategy. Adoption- The intention of the programme to take it up further and the factors associated with the uptake of this strategy. Perceived usefulness (Appropriateness)- The perceived utility of the components of the strategy. Feasibility-the extent to which this strategy could be carried out as planned Fidelity- the proportion of participants eligible for this strategy and the proportion who actually received it. Coverage- the proportion of participants who were identified and eligible for TPT received and completed the treatment 3. The various enabling factors and barriers in implementing the comprehensive intervention strategy and improving the retention at each step of the TB infection cascade of care. |
| Keywords | Tuberculosis, CRITIC study |
Research Details
| Student research | No |
| Start Date | 01-Jan-2025 |
| End Date | 30-Sep-2026 |
| Key Implementing Institution | Ministry of Health |
| Multi-country research | Yes |
| Indonesia, India, Nepal, Sri Lanka | |
| Nationwide research | Yes |
| Research Domain(s) | Communicable Disease Research |
| Research field(s) | Tuberculosis |
| Involves human subjects | Yes |
| Intervention Evaluation Research | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | Approved |