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Potential gains in population accessibility to TB testing services in Pakistan

Case study

Evaluating potential gains in population accessibility to TB testing services through optimal expansion of equipment and sample referrals in one province of Pakistan

Objective

Evaluate potential gains in population accessibility to TB diagnostic services in one province of Pakistan in 2023 compared to 2021 following the adoption of WHO recommended upfront molecular testing through optimal expansion and the setup of a sample referral system.

Analysis focus

Measuring accessibility gains from increased TB testing capacity through placement of GeneXperts at new sites.

Assessing additional accessibility gains from opening sample referrals between collection sites and testing sites.

Key data sources

  • Health facilities data: Geocodes from 2021 and 2023.
  • Population data: 2020 census data from WorldPop.
  • Travel time calculations: Used Open Route Service to determine travel time isochrones.

Key findings

2021 baseline2023 Optimized network2023 Optimized network
Sites with GeneXpert149149 + 101 (250)250
Testing coverage
(Testing sites + collection sites)
149250708
Population Accessibility, %38%46%60%
Population Accessibility, n. of people46 million55 million72 million
  • In 2021, 149 sites had GeneXpert and only on-site testing was performed, with no sample referral system in place. The population coverage was 38% (46 million people).
  • In 2023, a Diagnostic Network Optimization analysis was conducted in Pakistan to optimize the placement of GeneXpert devices for improved equitable access. The first recommendation was to add GeneXperts at 101 new sites, which would increase coverage to 46% (55 million people).
  • Aside from increasing testing capacity, the DNO recommended network also looked at the implications of opening up sample referrals to 708 health facilities, further improving accessibility to 60% (72 million people).

Implications

  • The DxGeoMap analysis provides a valuable tool for assessing accessibility gains of system strengthening interventions, both in terms of testing capacity and sample referrals.
  • Future potential application includes using similar analyses to assist the NTP in making informed policy decisions regarding the placement of X-rays or other diagnostic tests to ensure equitable access to services across Pakistan.