Specialists from the SHOPS Plus programs in India and Nigeria presented at the 50th Union World Conference on Lung Health, October 30 to November 2, 2019, in Hyderabad, India. The conference is the world’s largest gathering of clinicians and public health workers, health program managers, policymakers, researchers, and advocates working to end the suffering caused by lung disease. The project's India and Nigeria teams presented on tuberculosis research and lessons learned from program implementation.
Oommen George, director of TB control and care for the SHOPS Plus program in India, presented the project’s TB anti-stigma research and subsequent social and behavior change communication campaign. The presentation, “Understanding stigma associated with TB: unraveling a silent barrier to TB care in India,” summarizes research-based evidence generated by SHOPS Plus. The project learned that stigma stems from the fear of infection and the fear that TB will “never go away,” leading to death and financial ruin. Findings were used to inform the project’s anti-stigma campaign, which emphasized the bond of families and loved ones. Dr. George discussed how stigma is a barrier to effective TB management as it results in vicious cycles of isolation, social exclusion, poverty, low self-esteem, and compromised efficacy. He advocated for stigma-free TB care in which management of the disease includes the care of medical needs and the recognition of the social suffering that TB can cause.
The TB technical director for SHOPS Plus in Nigeria, Bolanle Olusola-Faleye, presented “Increasing TB case detection rate through the public-private mix: A progressive and productive Nigeria experience” during a workshop coordinated by the World Health Organization and the Stop TB Partnership. The presentation drew on lessons learned from the first year of the TB program implementation, such as how there is no single model for public-private engagement when it comes to TB. In Nigeria, the SHOPS Plus team applied a private provider network model originally piloted by SHOPS in India to increase TB detection in the private sector. The team found they had to adapt the model to fit not only the Nigerian context but also different contexts within Nigeria: different states and various private sector cadres required interventions to be modified for them to be effective. Also, shifting the focus from being provider-centered to being patient-centered allowed the program to address bottlenecks that prevented patients from accessing screening, testing, and treatment. Some other important lessons included how the program’s effective use of real-time data allowed for the rapid implementation and evaluation of problem-solving and the optimization of modifications to program processes.
The two SHOPS Plus programs first worked together when Dr. George visited the Nigeria program in June 2018. Following this visit, the project jointly organized a site visit of Nigerian TB experts to India in early 2019. Since then, the programs have made significant progress in implementation and learning with routine technical meetings and strengthening TB treatment and stigma reduction efforts.