Strengthening the national TB program in the Philippines

Tuberculosis (TB) is a preventable and curable disease. Yet each year it kills 1.5 million people.

It’s a bacterial infection that mostly affects the lungs but can also affect other parts of the body including kidneys, bones and brain.

Misuse and mismanagement of TB treatments such as antibiotics has led to the emergence of multi-drug resistant variants (MDR-TB).

While the Philippines has made great strides in TB control it’s still in the top eight countries globally for TB rates.  In 2016, the national tuberculosis prevalence survey, conducted by the country’s Department of Health, revealed that there are likely one million people in the country living with active TB disease.

To support the National Tuberculosis Control Programme and other decision-makers to address this challenge, a UK-Philippines research team developed a way to evaluate several diagnostic strategies at the same time to make projections. For example, they could project the amount of people being diagnosed with TB and the associated costs to the health system and patients.

The project team initially applied the model to primary data collected from six health centres in the province of Cavite; one of the most industrialized and fastest-growing provinces in the Philippines. As of 2020, it has a population of over 4 million.

The team monitored

  • Changes in the volume of people being diagnosed with TB
  • The duration of TB diagnoses following different treatments
  • The associated costs to the health system and the patient.

By the final year of their project, the team had already reached out to all 17 administrative regions of the Philippines to model impacts of new TB diagnostic strategies.

“TB-FIT is NTP’s first subnational modelling exercise. Unlike other TB models which focus on the country level, this model may be applied at facility, province, or regional level. Through the TB-FIT project, not only did I develop my modelling knowledge but also skills in new technology [Lanner’s Witness Software].” – Donna Mae Gaviola, Department of Health -National Tuberculosis Control Programme

Information generated by the TB-FIT model can now be used by Department of Health, the National Tuberculosis Programme, and other stakeholders. It provides the evidence to help roll-out new TB diagnostic strategies. Insight provided by the model takes into consideration cost-effectiveness as well as resource capacity and needs of the hospital, local government unit, and the community.

TB-FIT has helped with the upgrading of the National Tuberculosis Programme’s Integrated TB Information System.  It now incorporates the recommendations of this study. Data is collected that previously wouldn’t be during initial patient screening. Possible active TB patients and household income of diagnosed patients is monitored.  This upgrade enabled the National Tuberculosis Programme to promote policy change and devote attention to investing in better diagnostic technologies.

Following the survey results, the project team made recommendations to the World Health Organization (WHO) TB patient cost survey. The survey tool now considers underreporting of patient costs pre-TB diagnosis.

Follow-on-funding has enabled a second phase of the study. Dubbed as TB-FIT II, the study monitors how active TB cases are found in 5 provinces. Guidelines for how TB cases can be diagnosed will be created. The team will run workshops to raise awareness for TB monitoring which can expand to other diseases.

Impact Assessment of Diagnostic Tools and Algorithms for Multi-Drug Resistant (MDR-TB) and Drug Sensitive Tuberculosis (TB) in the Philippines (TB-FIT Project)

Project Leads: Dr. Bertie Squire, Liverpool School of Tropical Medicine, UK and Dr. Charles Yu, De La Salle Medical and Health Science Institute, Philippines

Delivery Partners: Medical Research Council, part of UK Research and Innovation, UK and the Department of Science and Technology Philippine Council for Health Research and Development, Philippines