PROJECT

Comprehensive intervention strategy to improve retention in TB infection cascade of care in high-risk groups through a person-centered approach in the SEAR countries (CRITIC study)

January 2025 - September 2027

Objectives:

To determine the effectiveness of a comprehensive intervention strategy in ensuring at least 80% retention in each step of the TB infection cascade of care among the high-risk populations compared with current practices and to identify implementation barriers and facilitators and assess the cost effectiveness of the strategy.

Study Overview:

This is an effectiveness-implementation hybrid type 2, multicountry study being conducted in selected provinces and districts of Bhutan, India, Indonesia, Nepal, and Sri Lanka. Using a mixed method approach for pre- and post- intervention comparisons, this study will evaluate a comprehensive person-centred intervention package to improve retention across the tuberculosis (TB) infection cascade of care among household and close contacts of persons with TB, people living with HIV, and other high-risk populations. The package comprises of integrated screening for TB disease, chest radiography using handheld and facility-based digital X-ray systems, newer TB infection testing methods, enhanced counselling, shorter TB preventive treatment regimens, digital adherence technologies, and real-time electronic monitoring systems.

Study Approach:

This is an implementation research study being conducted within the National TB programmes of the countries Quantitative and qualitative methods will be triangulated to assess intervention effectiveness, implementation outcomes, contextual influences, scalability and sustainability.

Expected Public Health Impact:

The evidence generated could serve as a model for large-scale implementation across SEAR countries and other high TB burden regions, inform policy and programme implementation, strengthen TB surveillance systems, and support the development of sustainable strategies for TB prevention. This will also contribute substantially toward reducing TB transmission, preventing progression from infection to disease, and accelerating progress toward global TB elimination goals.