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Abstract Background Private providers (PPs), rather than public facilities, are often the first point of contact in the health system for people with tuberculosis (TB). However, PP’s potential for enhancing TB detection remains underutilized. Methods TB REACH is an initiative of Stop TB Partnership focused on improving TB detection and notification. We analyzed the results of interventions using private provider engagement (PPE) to impact TB detection and notification across four TB REACH funding waves from May 2018 through March 2022. Results Overall, 35 projects documented screening of 13,038,586 people for TB, referral of 384,364 (3% of those screened) for diagnostic testing, and testing of 332,266 (86%) people. In total, 64,456 all forms of TB were diagnosed, and 62,830 (97% of those diagnosed) were linked to treatment. To diagnose one person with TB, the overall number needed to screen and test was, respectively, 281 (range across projects: 2–8,705) and 7 (range across projects: 1–24). Twenty-five projects mapped 69,187 PPs, both formal and informal, and engaged 21,206 (31%) providers during the intervention period, 12,211 (58%) of whom actively referred at least one person with TB symptoms during the intervention period. During the implementation period, TB notifications in the intervention areas increased by 25% (n = 61,123; from 246,845 to 307,968), with 20% of the total TB notifications attributed to the PPE projects. The mean and median cost per person started on treatment through the PPE projects was USD 221 and USD 481 (range across projects: 23 − 8,689). Conclusions Our findings suggest that structured and targeted PPE enhances TB case finding and contribute in closing the gap of missing cases. These results emphasize the need for wider implementation and scale-up of PPE in the TB response.

Abstract Introduction In Pakistan, almost one-third of people who develop tuberculosis (TB) are missed by the National TB Program (NTP). A considerable number of people with TB receive treatment in the private sector but remain unnotified. This study documents the outcomes of an intervention to identify people with TB through private pharmacy engagement, building on mapping TB medicine sales in Punjab Province. Methods A comprehensive intervention was carried out in four districts of Punjab with high anti-TB drug sales, comprising a policy change requiring mandatory notification of TB medication sales, mapping and engaging pharmacies selling anti-TB drugs, reporting through a novel ‘eTB’ mobile application and providing support via a call center. We collected both historical and prospective TB notification data from the intervention and control districts. The primary outcome was the change in TB notifications during the intervention period compared with historical and control notifications. Results Over the 12-month intervention period, 15,669 people with TB were reported from 2,943 pharmacies in four districts. Among the people identified, 88% were male (n = 13,673), 95% had pulmonary disease (n = 14,969), and 4,256 (27%) were bacteriologically confirmed. Chain pharmacies (n = 14) contributed to 39% of the yield. TB notifications increased by 17,462 (+ 34%) over the baseline period compared with an 8% increase in the control districts. The number of bacteriologically confirmed notifications increased by 32% compared with 16% in the control districts. The proportion of bacteriological confirmation was similar before and during the intervention. Conclusion The results of the largest TB intervention with pharmacies globally showed incredible potential to link people with TB who are receiving care in the private sector. Mapping TB medicine sales in the private sector with tailored interventions can contribute to closing the gap in notifications where anti-TB drug sales in the private sector are prevalent.