Closing the Gap: Finding Untreated TB Cases

At a glance

  • Each year, over 10 million people develop tuberculosis (TB) around the world.
  • Over 2.7 million people who develop TB remain undiagnosed and untreated.
  • Progress on the TB epidemic in the U.S. hinges on finding and treating these millions of people.
  • CDC's Clinic Laboratory Interface Continuous Quality Improvement (CLICQ!) program addresses the urgent need for improved TB diagnosis and treatment by identifying and closing gaps in the TB care cascade.
Man in blue coat examines through microscope.

Background

Man in blue coat examines through microscope.
Drug-resistant TB strains can easily cross borders through international travel and lead to costly outbreaks in the U.S.

The first steps in eliminating TB are to test and treat everyone who becomes sick with the disease. However, each year, 2.7 million people who become sick with TB are undiagnosed and untreated. This gap results in poorer health outcomes, increased spread of TB across national and international borders, and millions of preventable deaths. Progress on the TB epidemic in the U.S. hinges on finding and treating these millions of people missed by health systems annually.

Did you know?

TB is spread through the air. If left undiagnosed and untreated, one person with TB disease can spread the disease to 10 to 15 more people each year, adding exponentially to the global and U.S. epidemic over time.

TB, especially drug-resistant strains, can easily cross borders through international travel, leading to costly outbreaks and reversing decades of TB progress in the U.S.

TB care cascade

To ensure each patient receives complete care, close collaboration and communication between laboratories and clinics are essential during every step of the process. The TB care cascade begins when a patient with symptoms visits a clinic. A doctor collects a sample, which then is sent from the clinic to a laboratory for diagnostic testing. Once tested, results are sent back to the clinic so the doctor can start the patient on treatment. Every step in this process must be efficient to ensure accurate diagnosis and timely treatment, which is crucial for curing patients and reducing further spread of TB.

Quality improvement through mentorship

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CLICQ! is a guided 12-week mentorship program designed to better identify and address gaps in TB screening, sample collection, testing, and treatment.

To effectively close the diagnostic and treatment gap and build a stronger global defense against TB, CDC developed the Clinic Laboratory Interface Continuous Quality Improvement ().

CLICQ! is a guided 12-week mentorship program designed to strengthen the relationship and coordination between laboratories and clinics to better identify and address gaps in TB screening, sample collection, testing, and treatment. Structured mentorship is a proven best practice and cost-effective strategy for quality improvement among healthcare providers and strengthening the public health workforce.

Workforce capacity investments

Building TB workforce capacity overseas is a vital investment for the U.S. It helps prevent drug-resistant strains and outbreaks from endangering American lives.

Experts in continuous quality improvement from ministries of health and implementing partners provide structured mentorship to laboratories and clinics enrolled in CLICQ!. The mentorship starts during learning sessions designed to strengthen essential knowledge and skills. Mentorship, including site visits and presentations through a virtual platform, provides guidance for project improvements, and fosters shared learning and case-based problem-solving. This ensures participants are engaged and supported, empowering healthcare providers to effectively tackle challenges.

The CLICQ! program also includes the Diagnostic Cascade Evaluation (DiCE) toolkit, which allows healthcare providers to analyze patient data on retention and turnaround times for key indicators.

Transformative results

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CLICQ! program has accelerated the timelines for TB diagnosis and treatment in Nigeria and Uganda.

The CLICQ! program is a powerful catalyst for strengthening the capabilities of healthcare providers, leading to expanded testing coverage, faster reporting of test results, and patients starting treatment sooner.

Improvements in Nigeria

CLICQ! was first launched in Nigeria, the country with the highest TB burden in Africa, in 2019. Since its launch, the program has driven remarkable advancements in the TB diagnostic cascade following the 12-week mentorship. Notably, there was a 36% surge in samples collected from people with TB symptoms and a 15% increase in the number of patients diagnosed with TB who started treatment. Furthermore, the program reduced the time from sample collection to confirmed TB diagnosis by over five days and decreased the time from sample collection to treatment initiation by nearly six days.

CLICQ! helps healthcare providers generate reliable, cost-effective data, and sustainable TB healthcare processes which enable them to achieve their goal of improving care and enhancing patient outcomes.

- Onyekachi Awa Agbai, TB/HIV Laboratory Focal Person, Benue State, Nigeria

Improvements in Uganda

Building on the remarkable success of CLICQ! in Nigeria, CDC expanded the program to Uganda in 2021, similarly achieving impressive results. Following the 12-week mentorship, Uganda experienced a 44% increase in samples collected from people with TB symptoms, and a 37% increase in the number of people diagnosed with TB who started treatment. The program also accelerated the timelines for TB diagnosis and treatment, achieving a 2-day reduction from sample collection to confirmed diagnosis, and an impressive 20-day decrease from sample collection to treatment initiation.

These accomplishments highlight the effectiveness of the CLICQ! program in strengthening TB care and ensuring timely interventions for patients in Nigeria and Uganda.

Scaling success: Beyond TB in Nigeria and Uganda

Man in laboratory looks through a microscope.
By investing in and strengthening fundamental laboratory capabilities abroad, the U.S. helps create a global network of prepared health systems.

CLICQ! enables countries to better allocate resources, monitor progress, and adapt strategies based on real-time feedback. The success of CLICQ! in Nigeria and Uganda has paved the way for its planning and implementation in additional countries such as Cote d'Ivoire, Kenya, Namibia, Tanzania, and Vietnam. The DiCE toolkit is also customizable for other pathogens, demonstrating the program's cross-cutting ability to improve healthcare delivery on a broader scale.

The mentorship model equips healthcare providers and laboratory staff with the knowledge and skills to take ownership of their processes and health outcomes, lowering dependence on donor support and facilitating a country's transition to self-reliance. This approach can be applied beyond TB, building a robust healthcare system capable of detecting and responding to disease outbreaks.

By investing in and strengthening fundamental laboratory capabilities abroad, the U.S. helps create a global network of prepared health systems.

This ensures that infectious disease threats are identified and contained quickly at their source, and protects American communities from potential widespread outbreaks and costly public health emergencies.

By addressing gaps in the care cascade, CLICQ! is taking the first step in finding the millions of people with undiagnosed TB and connecting them to lifesaving treatment, reducing the continued spread of disease. As a result, the U.S. and countries around the world are moving closer to eliminating TB. Through continued collaboration, CDC ensures that no TB case goes untreated and that each person receives quality and timely care to live a long and healthy life.

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Content Source:
Global Health Center