How Do We Motivate People to Seek TB Care?

The Challenge

Through our first-of-its-kind study of 85,000 households across the city of Chennai, India, we identified an important subgroup of TB — symptomatic people who do not promptly seek care: middle-aged, employed men who drink or smoke. This subgroup had the highest risk of getting TB, yet sought care at the lowest rates. Despite being at high risk of spreading the disease and dying from it, these men aren’t being reached by many public health interventions.

Our Approach

We wanted to explore what interventions would be most effective in convincing these men to seek and obtain care for TB symptoms, and test new channels for reaching them – primarily digital channels, since we knew that many in our target group are heavy cellphone users. Continuing our partnership with the Clinton Health Access Initiative and the Greater Chennai Foundation, we launched a pilot program in the fall of 2020 to test the feasibility and effectiveness of targeting high-risk men through digital channels.

Key Results

As we carry out the pilot, we are testing a number of important questions:

• Do digital channels work to reach this key subgroup? If so, which channels are effective?
• Do new types of messages about TB care-seeking encourage people to change their behaviors?
• Can we make it easier for people to find where to seek care, and at more convenient hours?
• Should we redeploy more in-person interventions, such as door-to-door TB screenings, to more effectively reach this group?

Using precision approaches to public health helps us to use the right approach at the right time to improve health outcomes for targeted groups of people. Our research in Chennai provided us with an opportunity to adopt a user-centric, precision public health approach to increase TB care seeking and close the TB gap – specifically, among a target group of employed, middle-aged men who we had learned were not being effectively reached or served by current public health messages or services regarding TB. Men in this group were aware of the disease but were less likely to seek care, even when experiencing symptoms. Their low perception of the risk of TB, combined with their unwillingness to seek care, put them at high risk of contracting and spreading the disease. 

Their major obstacles? Not money, but time and convenience. These employed men said they had limited time for seeking care, and the places for doing so were inconvenient. To address these challenges, we developed a pilot program to test various digital channels and in-person approaches to find the most effective interventions and messages for these TB-presumptive men. 

We are testing different digital messages about financial risk and family responsibility, providing information on convenient places to seek care, and offering appointment scheduling and reminders. We are also exploring the possibility of expanding telehealth offerings beyond its current use for TB treatment and adherence, to TB screening, triage, and referrals for patients who need in-person care. 

Given the time and convenience barriers for this population, we are also testing a more flexible, decentralized process for delivering TB care services. Healthcare vans could provide workplace screenings, weekend appointments, or after-hours services in the community, making it easy for these men to seek care close to home.

As we find new and effective ways to encourage these men to seek care, we believe these strategies will not only improve health outcomes for this target group, but also reduce the risk and prevalence of TB in their communities. 

This novel approach will be one of the first systematic applications of comprehensive digital approaches to target men for TB care-seeking. We look forward to sharing the results of our pilot, once ready, so that global public health programs can scale and adapt these interventions in countries around the world.