PROJECT

Reducing pre-treatment loss to follow-up among individuals diagnosed with TB through behavioral nudging intervention - A multi-centric mixed methods implementation study

June 2024 - June 2026

Objectives:

i. To assess gaps in the patient referral process and treatment initiation gaps among newly diagnosed DS-TB patients
ii. To evaluate the incremental effectiveness of a patient behavioral nudging intervention in reducing PTLFU rates as compared to standard of care among newly diagnosed DS-TB patients.
iii. Evaluate the implementation process of a behavioral nudging intervention from the perspective of patients, caregivers and health care provider’s

Study Overview:

Pre-treatment loss to follow-up (PTLFU) and treatment initiation delays remain major gaps in the TB patient cascade of care in India. PTLFU patients (who are diagnosed but have not initiated TB treatment immediately) remain infectious, experience poor treatment outcomes, and suffer high mortality rates. As of 2020 about 6% of the notified patients have not initiated treatment for TB subsequently in India. There is a need for developing behavior change interventions that could address patient-level barriers and gaps that lead to PTLFU.

Study Approach:

A multi-centric mixed-methods approach, with a hybrid two-arm cluster intervention design is used to evaluate the incremental effectiveness and implementation aspects of delivering a patient behavioral nudging intervention using an implementation research PRODCUES (Problem, Objective, and Design, (end-) Users, Co-creators, Evaluation, and Scalability) framework.

Expected Public Health Impact:

The study is expected to generate evidence on the effectiveness, feasibility, acceptability, and implementation of behavioral nudging interventions and the potential of behavioral nudges to facilitate timely treatment initiation and promote sustained, health-seeking behaviors among persons affected by TB, across diverse cultural and programmatic settings. The findings will provide insights into how patient-centered behavioral interventions can complement existing health-system strategies and strengthen the effectiveness of the National Tuberculosis Elimination Programme.