Tuberculosis (TB) constitutes a major public health challenge and is one of the top 10 causes of death worldwide. In 2015, over 10.4 million people fell ill with TB and 1.8 million died from the disease; an estimated 480,000 people developed multidrug-resistant TB (MDR-TB); and an estimated 1 million children became ill with TB, and 170,000 children died due to TB. According to the WHO, the incidence of TB cases in Pakistan for all types are 270/100,000. A cross-sectional study was designed, and a potential 2,000 registered pharmacies from different rural and urban/peri-urban areas of 12 districts across Pakistan were selected. Supervisors, pharmacy focal persons, students and faculty coordinators from seven universities were trained on TB case identification, a referral mechanism, and collaboration with the program, followed by signing MOU. In phase 1 an entire (100%) pharmacy staff was trained; followed by the second phase, in which 96% of focal persons were trained from private pharmacies nation-wide. A total of 4,085 referrals were sent to the trained doctors, out of which 622 cases were identified. The percentage of case registration was 14.5% of total referrals. The highest number of TB presumptives (527) were referred from private pharmacies of district Muzafargarh, and 136 TB cases were registered out of these referrals. For a significant impact on case detection, it is important to acknowledge a number of concerns expressed by pharmacists and attempt to change both client's and provider's expectations with regard to the pharmacist's role.
Keywords: Case detection; new referral system; private pharmacies; public-private mix; tuberculosis.