Tuberculosis (TB) is a leading cause of death worldwide, with India having the largest number of people with TB and a significant number who put off seeking care for TB-related symptoms. While previous research suggested that lack of awareness about TB is a key factor in delaying care seeking, a study of TB patients in the south Indian city of Chennai by Surgo Foundation found otherwise, and identified a key subpopulation for targeting pro-care seeking messages.
The first-of-its-kind study, conducted by Surgo Foundation in partnership with the Clinton Health Access Initiative and the Greater Chennai Corporation in 2018-19 and published in the latest edition of BMJ Global Health, found that TB awareness is widespread, and not associated with care-seeking delays--suggesting that intervention efforts should focus less on awareness campaigns and more on making it easier to visit a doctor.
Surgo researchers identified multiple barriers to prompt care-seeking, including:
demographic factors such as occupation (lack of time, rather than money, was a significant barrier to care-seeking)
beliefs around perceived risk (higher risk perception → care-seeking)
normalization of TB (lower care-seeking)
symptom-related factors, such as sustained weight loss or having a fever for at least 7 days (higher care-seeking)
Surgo identified distinct segments of the population to better understand TB-symptomatic people in Chennai who do not promptly seek care. This process revealed a key subpopulation: employed men who problem-drink and smoke, comprising just over half -- 54% -- of this population. Surgo is currently working with its partners to design and deploy new interventions that reach this target population.
“This work sums up the kind of impact we strive for: Designing a precision approach to a significant public health problem, and developing targeted interventions for key population segments,” said Sema Sgaier, executive director of Surgo Foundation. “In this case, we’ve made significant strides to address India’s struggle with TB by identifying a subpopulation -- employed men -- that seeks care for TB at the lowest rates, while comprising 64% of the risk. We learned that we need to make care seeking as convenient as possible for this group, while also increasing their perceptions of the risks of not getting treated.”
Read Surgo’s paper, “Understanding why at-risk population segments do not seek care for tuberculosis: a precision public health approach in South India,” in the September 2020 edition of BMJ Global Health.