Grant: Project Grant

India has the highest burden of tuberculosis (TB) globally, accounting for a staggering one-third of all worldwide TB cases and deaths. A substantial proportion of TB patients in India initially seek care from private and informal healthcare providers (IPs), especially in rural areas and urban slums. Our prior research in India has shown that IPs have sub-optimal level of TB care knowledge, resulting in delayed referrals and adversely affecting the timely diagnosis and treatment of TB cases. To enhance the quality of care and address this issue, it is essential to provide training to IPs, enabling them to identify presumptive TB cases and equipping them with a simple TB diagnostic tool. We will invite IPs in urban and rural Patna (India) to participate in this project, and they will be randomly assigned to two groups: the control group or the intervention group. The control group will receive comprehensive training on how to identify patients with symptoms suggestive of TB and how to make appropriate referrals for further evaluation. The intervention group will undergo the same training as the control group but will also receive a specialized training on the collection, handling and storage of tongue swab samples for TB testing. We will measure the impact of the intervention comparing key outcomes between two groups, such as the difference in count of TB cases diagnosed in intervention and control arms, number of presumptive TB cases identified, number of tongue swabs collected, and proportion of successful referrals made by IPs in both arms. Our findings will provide evidence on whether training IPs will improve TB case diagnosis, and whether enabling them to collect tongue swabs for TB testing can amplify this impact. We will present the study results at international conferences, and aim for publication in high-impact journals. Our results will also be shared with policy bodies to inform private provider engagement strategies.