Programmatic Management of TB Preventive Therapy
Donor: GFATM (via FIND India & CHAI as PRs)
Geography: AP, Telangana, Punjab, Delhi, Haryana
Duration: Apr 2021 – Mar 2024
Project Focus : Expanded TB preventive therapy (TPT) among household contacts of TB patients across public and private sectors.
Key Results:
- Reached 157,733 index TB patients for counselling
- Screened 390,473 household contacts
- Initiated 210,229 eligible individuals on TPT
- Achieved 135,438 completions (77% success rate)
Sustained Impact : Significantly contributed to breaking TB transmission cycles through large-scale preventive therapy, while strengthening systematic contact tracing mechanisms within NTEP.
During the period 2010 to 2018, the following projects were implemented
1. Project Name : CEPT (Campaign for Education, Prevention and Treatment of TB: This project aimed at improving the health of TB affected women, children and people living with HIV & AIDS (PLHA) especially from the disadvantaged groups such as labourers from textile, brick, gauze & bandage, and match & firework factories who are prone to TB infections due to dust pollution.
Operational area : The CEPT project was implemented in all the 11 blocks of the Virudhunagar District and 6 blocks of the Kanchipuram District from the state of Tamil Nadu, and these were selected as they are home to large numbers of socially and economically disadvantaged populations.
2. Project Name : PRATAM TB Initiative: The Pharmacies and RHCP as TB Care Animators and Motivators (PRATAM) project recognizes that if home remedies do not work, patients avoid going to a doctor as the first point of contact. Instead, they approach their nearest pharmacist (chemist) or Rural Health Care Providers (RHCPs)for medication. This is a challenge as chemists or RHCPs are not well-informed about identifying presumptive TB individuals and fail to refer them to the government programme. The PRATAM project addressed this gap by building the capacities of the Chemists and RHCPs on timely identification of TB presumptive cases.
Operational Area : The project was operational in 15 Tuberculosis Units (TUs) each covering around 2, 50,000 population in the South Indian state of Telangana.
3. TOSS (TB One Stop Services) – Faster TB Detection : The project titled ‘TB One Stop Services (TOSS)’ aimed at increasing the rate of TB screenings and improve diagnosis by motivating the Private Healthcare providers, who are generally the first contacts of patients for any medication.
Operational Area : The project was operational in two districts of Andhra Pradesh namely Kurnool & Chittoor Districts, engaging private health care providers through hub and spoke model referral mechanism.
4. DR-TB Linkage : TB Diagnostic Scale-Up Initiative: This pilot project aimed to scale up the access and coverage of the presumptive and MDR-TB patients to Universal Drug Susceptibility Test (UDST). Moreover, it aimed to build stronger linkages from prioritized high load Designated Microscopic Centres (DMCs) to districts Nucleic Acid Amplification Tests (NAATs) and subsequently develop linkages to centrally placed Intermediately Reference Laboratory (IRL) to address dropout rates and optimize treatment.
Operational Area : The project was operational in six high burden & challenging areas in Telangana namely Hyderabad, Jayashankar Bhupalapally, Mulugu, Asifabad, Gadwal and Wanaparthy.
Objectives :
Support the efforts of National Tuberculosis Elimination Programme’s (NTEP) of ensuring optimum & timely coverage of presumptive/identified TB patients by streamlining the sub-optimal linkages between DMCs–NAAT Labs–IRL Lab for access of NAAT, line probe assay (LPA) and Liquid Cultures tests. Streamline & strengthen sputum collection & transportation between identified high burden DMCs, NAAT Labs & IRL.
Optimize turnaround time from the point of collection of samples to reporting the testing results
Minimize the recording and reporting discrepancies at selected DMCs, Cartridge Based Nucleic Acid Amplification Test (CBNAAT) and IRL levels.
Mitigate the gap existing between the follow up samples and ensure that the follow up samples are retrieved & processed at the stipulated intervals as per the guidelines.
5. TAP : Bridging Gaps in TB Care: Project titled “Improved access to TB services for underserved communities in Andhra Pradesh (TAP)” aimed at reducing levels of TB and TB/HIV co-infection, and increase access to effective health services, through sensitised and empowered communities and local advocacy’. The target communities included tribal and fishing communities, women and children and people living in sparsely populated areas.
Operational Area : The project was operational in 27 blocks spread across six districts of Andhra Pradesh namely, East Godavari Krishna, Nellore, Prakasham, Srikakulum and Vishakhapatnam.
Objective : Increase awareness on TB and HIV confection; Increase utilization of free government health services; Establish community structures that promote and support health rights, health seeking behaviour and a stigma-free health centre environment; Enhance knowledge of TB amongst community; Improve TB diagnostic and treatment services; Improve access of patients diagnosed with TB and HIV to free treatment in a self-stigma/ community-stigma free environment.
6. Transforming DR-TB Care in Rajasthan : This pilot project aimed to develop an improved patient centric model for DR-TB care in public sector. It worked on reducing the touch points, improving linkages and facilitating decentralization in order to provide better care to the patient.
Operational Area : This project was operational in the state of Rajasthan and covering 6 DR-TB centres.
7. Axshya India : Towards a TB-Free Future: Axshya means ‘where there is no TB’. The ultimate goal of the project was to ensure universal access to patients to quality TB services and eliminate TB. It aimed to improve the rates of TB diagnosis and treatment especially for the vulnerable people in under-served communities such as women, children, tribal communities, urban slum dwellers and migrant populations who might miss out on vital TB care.
Operational area : It was implemented across multiple districts of united Andhra Pradesh.
Objective : Ensure universal access to TB care and diagnosis facilities in the government health sector ensuring ICTC referral linkages and educate communities on TB and the role of RNTCP.
- Objectives
- Approach
- Activities
- Expected outcome
- Strengthen the community response to TB
- Improve the access of the TB affected communities to TB services such as diagnosis and treatment at the government facilities and contribute to improved health.
- Build the overall knowledge of the TB affected communities and general communities about general health education, personal hygiene, importance of sanitation and nutritious food.
- Raise awareness of the TB affected communities on government schemes such as Old Age Pension (OAP), Widow Pension and Disability Pension.
- Reduce the stigma and discrimination faced by the TB affected PLHAs.
CEPT adopted an approach of organizing the TB affected communities into Rainbow TB Association (RTBF) and building their capacities. Moreover, activities such as distributing IEC material and conducting Behaviour Change Communication were also adopted under the project.
- Bringing the TB Patients and other groups under the umbrella of TB Forums
- Distributing IEC material in the target groups for creating awareness
- Conducting health education activities to reach wider population
- Linking the identified patients to the TB units for notification, referral and treatment
- Raised awareness about TB services among the marginalised communities with special reference to women, children and PLHAs
- Increased knowledge about general health education, personal hygiene, importance of sanitation and nutritious food in the targeted communities and general population.
- Improved access of the PLHAs to the government facilities offering TB services such as diagnosis and treatment resulting into improved health
- Increase in the number of people with TB symptoms accessing designated TB diagnostic facilities for initial sputum test
- Decrease in stigma and discrimination towards the PLHAs affected by TB
