Abstract
Background: The previous study, entitled “The Development of Multi-Sectoral Approaches to End TB in Municipality and Central District (year 1)" was conducted in Chiangrai province in 2019 and 2020 revealed private pharmacies and clinics contributed to 25% tuberculosis (TB) detection rate (6 of 24 referred cases). Subsequently, this project was extended and implemented in 8 provinces of the Health Region 1 amid the Covid-19 pandemic. The project was coordinated by 8 operational researchers (OR) who are government health staff in provinces. The study aimed to develop a model involving pharmacies/clinics to screen and refer persons with TB risks and to investigate factors contributing to the implementation outcomes among 8 provinces. Methods: Developing two digital innovations, i.e. TB-Refer, a web-application for TB screening and referral and a TB online training course. The data were collected for 9 months and analyzed database of TB-Refer. The qualitative methods included in-depth interviews with OR, provincial TB administrators (Mr.TB), hospital staff and the pharmacies/clinics with and without referral cases. Results: The participation rate of pharmacies in 8 provinces is 50.4% (143/284) with a range of 12.7%-100% participation. Participation from clinics is only 4.6% (11/240) with no-participation in 2 provinces. Of the 143 pharmacies, 19 (13.3%) pharmacies screen and referred 37 persons with TB risk to the hospitals, while 2 out of 11 clinics screen and referred 2 cases made up to a total of 39 referred cases (38 symptomatic cases and 1 asymptomatic contact case). Only 19 referred persons arrived the hospitals and received TB screening and one pulmonary TB with sputum positive (AFB 3+) was detected. Fifty-seven pharmacists and five clinics doctors/staff enrolled and completed this training. The median scores of drug stores were increased from 16 (IQR = 4) to 23 (IQR = 2) (p < 0.001) while the mean scores of clinics were increased from 17.8 (SD 4.5) to 21.8 (SD 2.3) (p = 0.034). Drug stores and clinics completing the course had higher proportion of TB screening and referral cases to the hospitals than those without training (22.6% vs 7.6%, p=0.008). Among 8 provinces, only one province demonstrated regular referral and continuity of communications between OR and pharmacies/clinics. The OR of this province is a staff of disease control department who received excellent support from the department of consumer protection and public health pharmacies (CPHP), including supports from Mr.TB of the hospital and the provincial health office, particularly establishing a hospital’s fast track for referred patients. Conclusion and recommendations: It is feasible to involve drug stores and private clinic to screen and refer persons with TB risks to the hospital. The best model is the project’s coordinator should be a staff of disease control with good support of CPHP and provincial health authorities. Personals of drug stores and clinic should attend the TB online training course.
