MPH 504 Week 7 Global Health Intervention Plan Example

Global Health Intervention Plan: Household Contact Screening and Preventive Treatment for Tuberculosis in a Philippine City, Led by Its City Health Office

Student Name

Chamberlain University

MPH 504: Cultural Competency and Global Public Health

Instructor Name

Month Day, Year

Global Health Intervention Plan: Household Contact Screening and Preventive Treatment for Tuberculosis in a Philippine City, Led by Its City Health Office

The Problem and the Setting

The Philippines had an estimated TB incidence of 625 per 100,000 in 2024, and a national survey found that most people with confirmed TB did not report the symptoms that would lead to testing, while fewer than one in five people with symptoms had seen a health worker (Lansang et al., 2021). This plan concerns a composite city of about 350,000 people in the Visayas, referred to here as the partner city. At the national notification rate of about 470 per 100,000, the city would register roughly 1,650 TB cases a year. Its city health office runs TB services through health centers and relies on barangay health workers, community volunteers in each neighborhood, for home visits. Household members of people with TB are screened only if they come to a health center with symptoms.

Objective

Over 18 months, the plan aims to reach at least 80% of the household contacts of people with bacteriologically confirmed pulmonary TB using symptom questions and chest radiography, to detect TB disease earlier among them and to start TB preventive treatment in at least 70% of eligible contacts who do not have disease. The objective was agreed with the city health office, which identified household contacts as the group it most wanted to reach.

The Evidence and Whether It Transfers

The strongest evidence comes from Vietnam. In a cluster-randomized trial in 70 districts, household-contact investigation with clinical review and chest radiography at baseline and at 6, 12 and 24 months found 2.5 times as many TB cases among contacts as passive case finding alone, and 6.4 times as many smear-positive cases (Fox et al., 2018). A second trial in Ca Mau Province found that three annual rounds of community-wide screening with a molecular sputum test lowered TB prevalence in the fourth year by 44% (Marks et al., 2019).

Whether these results apply to the partner city depends on both applicability, whether the intervention can be delivered there, and transferability, whether its effect is likely to be similar (Wang et al., 2006).

Table 1

Transferability of the Vietnam Evidence to the Partner City

Note. Note. Vietnam burden from World Health Organization estimates; costs from Florentino et al. (2022).

The judgment is that the intervention is likely to work as well or better, given higher burden, but only if the plan addresses two differences: devolved governance, which means the city must own and fund the program, and the high costs families face, which would otherwise keep contacts from attending radiography appointments (Florentino et al., 2022).

Activities

The plan has four activities. First, within two weeks of each new confirmed case, a barangay health worker visits the household, lists contacts and asks the screening questions. Second, all contacts aged 5 and over receive a chest radiograph at the city hospital or the mobile unit, with sputum tests for anyone with symptoms or an abnormal film; younger children are assessed by a physician. Third, contacts without TB disease are offered preventive treatment through the national program, with a short regimen where available. Fourth, contacts are re-screened at 12 months.

Partnership and Roles

The city health officer leads the program and decides on its scope and budget; the national TB program provides drugs, test cartridges and reporting forms. Barangay health workers carry out visits and are paid an honorarium for each household screened. My role, as a public health nurse from the United States working with the city health office through a partnership between our county and the city's medical school, is limited to helping design the data system and analyze results with the city's TB coordinator, who will be first author on any report. Abimbola and Pai (2020) argue that global health partnerships too often keep decisions and credit with partners from wealthy countries; this plan puts both with the city.

Budget

The plan uses the national program's drugs and test supplies. The additional cost falls in three lines, estimated with the city health office and to be confirmed in its budget: barangay health worker honoraria for about 900 household visits a year; transport and meal allowances of PHP 500 per contact for each radiography visit, so that families do not bear travel costs; and mobile radiography sessions twice a month in the two districts farthest from the hospital. The city has asked that the allowances be funded from its own health budget, so that the program continues after the partnership ends.

Indicators

Five indicators will be reported every quarter to the city health board: the share of index cases whose households were visited within two weeks; the share of listed contacts screened with radiography; the number of TB cases found among contacts; the share of eligible contacts starting and completing preventive treatment; and, through a short survey, the share of households reporting costs above 20% of monthly income during screening.

Risks and How the Plan Responds

Three risks could undo the plan. The first is stigma at the household visit: a barangay health worker arriving at a home is visible to neighbors, and families may decline to list all contacts. The plan responds by scheduling visits at times the family chooses, by having the worker introduce the visit as a family health check, and by counting refusals so the city can see where the approach is not working. The second is a shortage of preventive treatment drugs, which has interrupted national supply in past years; the city health office will hold a three-month buffer and report stock levels with each quarterly indicator. The third is the end of the partnership itself. Programs that depend on an outside partner for analysis often stall when the partner leaves, so the data system will be built in the spreadsheet software the city already uses, and the city's TB coordinator will run every quarterly analysis from the second quarter onward, with my role shrinking to review on request.

References

Abimbola, S., & Pai, M. (2020). Will global health survive its decolonisation? The Lancet, 396(10263), 1627-1628. https://doi.org/10.1016/S0140-6736(20)32417-X

Florentino, J. L., Arao, R. M. L., Garfin, A. M. C., Gaviola, D. M. G., Tan, C. R., Yadav, R. P., Hiatt, T., Morishita, F., Siroka, A., Yamanaka, T., & Nishikiori, N. (2022). Expansion of social protection is necessary towards zero catastrophic costs due to TB: The first national TB patient cost survey in the Philippines. PLOS ONE, 17(2), e0264689. https://doi.org/10.1371/journal.pone.0264689

Fox, G. J., Nhung, N. V., Sy, D. N., Hoa, N. L. P., Anh, L. T. N., Anh, N. T., Hoa, N. B., Dung, N. H., Buu, T. N., Loi, N. T., Nhung, L. T., Hung, N. V., Lieu, P. T., Cuong, N. K., Cuong, P. D., Bestrashniy, J., Britton, W. J., & Marks, G. B. (2018). Household-contact investigation for detection of tuberculosis in Vietnam. New England Journal of Medicine, 378(3), 221-229. https://doi.org/10.1056/NEJMoa1700209

Lansang, M. A. D., Alejandria, M. M., Law, I., Juban, N. R., Amarillo, M. L. E., Sison, O. T., Cruz, J. R. B., Ang, C. F., Buensalido, J. A. L., Cañal, J. P. A., Castillo-Carandang, N. T., Cordero, C. P., Gaviola, D. M. G., Ladia, M. A. J., Mantaring, J. B. V., Mendoza, M. T., Salamat, M. S. S., Lam, H. Y., Tadolini, M., . . . Philippine NTPS 2016 Group. (2021). High TB burden and low notification rates in the Philippines: The 2016 national TB prevalence survey. PLOS ONE, 16(6), e0252240. https://doi.org/10.1371/journal.pone.0252240

Marks, G. B., Nguyen, N. V., Nguyen, P. T. B., Nguyen, T.-A., Nguyen, H. B., Tran, K. H., Nguyen, S. V., Luu, K. B., Tran, D. T. T., Vo, Q. T. N., Le, O. T. T., Nguyen, Y. H., Do, V. Q., Mason, P. H., Nguyen, V.-A. T., Ho, J., Sintchenko, V., Nguyen, L. N., Britton, W. J., & Fox, G. J. (2019). Community-wide screening for tuberculosis in a high-prevalence setting. New England Journal of Medicine, 381(14), 1347-1357. https://doi.org/10.1056/NEJMoa1902129

Wang, S., Moss, J. R., & Hiller, J. E. (2006). Applicability and transferability of interventions in evidence-based public health. Health Promotion International, 21(1), 76-83. https://doi.org/10.1093/heapro/dai025