Quality of Life as a Catalyst for Effective TB Treatment

With India aiming to eliminate Tuberculosis (TB) by 2025, ahead of the Sustainable Development Goal (#SDGs) target of 2030, its strategic focus is maximizing diagnosis and initiating clinical treatment of TB patients. Achieving this enormous goal requires an integrated approach, which includes treatment and relief from disease and addressing social, economic, and psychological factors. TB is a chronic disease that adversely affects the psycho-social and economic condition of TB patients, which is further compounded by its long treatment process, health complications, associated social stigma, and financial burden. These collectively impact the quality of life (QoL) of the patient. Poor QoL and a high risk of experiencing depression further affect treatment adherence by the TB patient.

The World Health Organization (WHO) essentially recommends the urgency to improve QoL for improving treatment adherence and their outcome for reducing TB mortality incidences.

Thrust on human-centric value-based approach

Quality-of-care/ value-based care (VBC) is an important focus area of Closing the Gaps in TB Care Cascade (CGC) Project, implemented by World Health Partners with financial support from USAID and technical support from Leapfrog to Value (L2V). The rationale for initiating VBC emanates from several studies, including WHO, which reveals that while out-of-pocket expenses for TB treatment in India have surged, the TB mortality rate has nearly doubled instead of going down. Meaning buying more healthcare hasn't produced better health.??

Therefore, the CGC Project came up with Value-based care (VBC) approach that measures the value of TB care by assessing both outcomes and costs. The VBC model aligns patients, payers, and providers around a common goal: achieving outcomes that matter to TB patients at the optimal cost. Its core hypothesis is that a human-centric approach to TB care can produce better results at a lower cost. WHP identified a decision framework to prioritize the interventions that improve QoL and PCE, and plugging the existing gaps and need and ease of action through stakeholder participation (frontline staff and program staff). ?

The intervention framework developed is backed by telephonic surveys carried out by WHP Executives in project districts (Surat and Gandhinagar in Gujarat and Ranchi and East Singhbhum in Jharkhand) to assess QoL, Patient Care Experience (PCE) (NTEP staff responsiveness), physical and mental well-being and cost of care at three critical stages during TB care cascade- at the beginning of treatment, End of the Intensive phase and End of treatment. Over 13, 000 patients were called out which over 5,000 shared responses.?

WHP has been advocating scale up and integration of QoL (physical and financial) and PCE variables in Nikshay. To address incidences of anxiety and depression reported during the survey, WHP initiated “Improvement loops” in Mental Health domain to improve the quality of services with the active involvement of the district team