Economic & Equity Analysis of Centralized vs Decentralized TB Diagnosis
While TB testing has improved greatly in the past decades, there is still a need to improve equitable, accessible, cost-effective, and affordable diagnostic testing approaches for TB. This project investigates the impact of decentralized versus centralized diagnostic approaches on economic and health outcomes and equitable access from a health system and patient perspective. We looked at data from 4200 patients in two high burden countries (Mozambique and Tanzania) in an effort to perform a cost-effectiveness and a benefit incidence analysis, map needs, and carry out qualitative research.
Decentralized TB diagnostic algorithms will become increasingly feasible with the introduction of innovative diagnostic tests, such as the TrueNat test, which solves some of the bottlenecks by bringing the diagnostic system closer to patients in more peripheral clinics.
Parallel to this, the WHO recently recommended centralized assays for TB diagnosis that allows for multi-disease diagnosis (e.g., HIV, hepatitis) and high-throughput testing which could generate economies of scale. According to the WHO, such platforms could enhance system efficiency, provide cost savings, expand patient access, and ultimately improve quality of care.
These diagnostic advancements raise new questions about whether to pursue a centralized or decentralized strategy. To inform this decision making, this project provides the evidence required beyond clinical/diagnostic effectiveness, looking into relevant policy issues such as costs in relation to benefits, the potential for financial risk protection, equity in access to diagnostics and resulting care, and affordability of the technology at national level.
A qualitative evaluation of preferences of healthcare providers, patients, and decision makers for the implementation of decentralized TB testing is also ongoing as part of the CORE trial.
Tongue Swab Tuberculosis Diagnostic Yield Study
This highly pragmatic cross-sectional study evaluates diagnostic yield of tongue-swab based vs. sputum based molecular TB testing. Tongue-swab based TB testing is anticipated to enable penetration of molecular testing for TB to lower-level health facilities in high burden countries where affected patients most often first seek care. While preliminary results currently suggest a sensitivity deficit of swab-based testing vs. sputum-based testing, a potential increased diagnostic yield, would favour swab-based testing. By reflecting outcomes that can be expected in routine care this study can provide important evidence to potentially support WHO policy and country-level uptake of swab-based molecular tests.