Table 1: Innovative New Approaches from Our Body of Work

Output 1: Summary of multiplier funding linked to the ESRC/DFID grant Theobald-Cuevas RES-167-25-0387

The ESRC DFID study “Identifying barriers to tuberculosis diagnosis and treatment under a new rapid diagnostic scheme” (RES-167-25-0387) involved research in Ethiopia, Yemen, Nepal and Nigeria. These are all countries with a high burden of tuberculosis, where patients often abandon the diagnostic process and fail to initiate treatment. We used multi-country and multi-stage surveys to describe the costs incurred accessing tuberculosis diagnostic services across these contexts and patients’ perception of the disease and services. These results were used to develop models to identify populations at risk of high expenditure for tuberculosis diagnosis and treatment. Complementary qualitative methods in Yemen and Ethiopia elicited participants’ perceptions of diagnostic and treatment processes, the barriers people face in accessing services and how services could be modified to improve access.

The multi-method approach deployed generated strong evidence across these contexts of the multiple challenges people with symptoms of tuberculosis face in accessing diagnosis through the classic passive approach to tuberculosis case finding (reliant on patients paying multiple visits to a health centre). Accessing services resulted in significant costs, especially clinic fees and transport and in particular among accompanied adults and from rural areas. Most participants (particularly women) attended the services with companions and were unprepared for the duration of the process. Besides costs, women faced many other particular difficulties in accessing services. The findings highlight how poverty, geography (distance from health centre), gender and age interplay to shape barriers to accessing tuberculosis diagnostic services at central level. This evidence (together with other evidence generated through accompanying studies and experience) has been pivotal in the development of a body of work that has taken forward the conceptualisation of equity and social justice in tuberculosis diagnosis processes. This body of work has promoted creative thinking about piloting different approaches to bring tuberculosis services closer to communities in Ethiopia, Yemen and Nigeria to increase the access of poor and marginalised groups to vital lifesaving tuberculosis diagnostic services. We have been very successful in testing several approaches described in the impacts section and have generated over £3,026,976 of research income to support further operational and intervention research to test out new approaches that bring the diagnosis closer to the communities in these country contexts. The table below details the grants linked to this ESRC/DFID grant and the last column describes how the evidence generated was used in developing the concepts. Key to these awards is the development of new and creative ways to bring tuberculosis diagnosis closer to communities to address and minimise the multiple barriers patients face accessing formal care.

Table 1: Innovative new approaches from our body of work