By David Bodapati
Bengaluru: Karnataka is one of the States in India with a good TB response with all the 31 districts aggressively working towards the National goal of Universal Access and Zero TB deaths as a part of End TB Strategy but certain challenges in notifying cases from the private sector and structural barriers for the vulnerable communities to access free treatment and care, means a lot more push is needed to integrate the response from all stakeholders.
The theme of World TB Day 2022 on March 24, ‘Invest to End TB. Save Lives’ conveys the urgent need to invest resources for both prevention and cure, to ramp up the fight against TB. Working closely with the Indian government’s ambitious National TB Elimination Programme (NTEP), Breaking the Barriers (BTB) project, uses community engagement as a central ploy in accelerating TB elimination.
There are about 90,000 cases on treatment every year in Karnataka with active disease and the total lost to follow up rate which was 10 per cent in 2009 is reduced to 2 per cent in 2021. The success rates of TB treatment, too, have improved from 76.9 per cent to 81.5 per cent (2018 to 2021). However, stigma and discrimination, socio-cultural barriers for vulnerable communities like people living with HIV, persons with TB staying alone, old patients above the age of 60 and people who are exposed to dust and other habits like use of tobacco and alcohol complicate things for the public health programme, which has roped in NGOs and civil society organisations for creating awareness and other support systems. People with co-morbidities and who are diagnosed with Drug Resistant TB also fall into these vulnerable groups.
KHPT’s Breaking the Barriers is a project that has created a strong impact in its short existence as it was built on the learnings from an earlier TB project called THALI, where the differential care model was a big success. The project focuses on the social side of the impact with a unique care model for the affected and vulnerable groups and involves a community engagement initiative to accelerate TB elimination in India. Armed with KHPT’s experience of two decades of evidence-based work involving grass-root communities with a scientific approach to public health innovations, the TB project involves community structures like ASHAs, Anganwadi workers, SHG members, civil society organisations, faith leaders and works with the district TB centres.
With staff working along the government district teams, BTB project is run in 87 TB treatment units in 15 districts reaching out to a vulnerable population of over 10 lakh in Assam and Bihar and over 34 lakh in Karnataka and Telangana. In Karnataka the project caters to 31 of the 272 TB treatment Units in five districts, with each TU reaching out to 2.5 lakh population. The five districts include Bengaluru Urban and four in the highly-vulnerable North Karnataka namely Bagalkot, Belgaum, Koppal and Bellary, the district with the highest prevalence in the State. The project reaches out to over 14,04,330 population where 1226 sites were mapped with clustered vulnerable populations.
The project seeks to fill the critical gap in addressing TB among the target population. The strategy is to innovate, test and demonstrate a set of pilots that address specific barriers to health in the contexts unique to each of these at-risk groups. A visit to some of these sites in Sangareddy, Warangal in Telangana State and, Ballari and Koppal in Karnataka revealed a human side to the challenge. Many innovations like starters kit, healthy buddy, phone a friend, TB mukt certificate and health auto help the communities over come stigma and access-related issues in a patriarchal society. Let us see how some of these innovations are helping the community on the road to end-TB.
Shankar (name changed) works in the mines in the industrial belt of Sangareddy district of Telangana. He could not take medicines openly in front of his fellow workers during his shift hours for fear of losing his job. He became irregular in consuming his TB medicines and soon fell sick and lost his job. But ahead of the World TB day Shankar is back to work, thanks to the TB mukt certificate.
“At KHPT, through the BTB project in four states, we have found that investing in vulnerable communities and building their capacities has empowered them to create a safe environment that enables recovery for persons with TB. Community engagement and partnerships between the health system and community leaders and structures are essential to sustain TB control efforts at the grassroots, and our interventions are designed to build and sustain such partnerships for TB elimination,” Mohan HL, CEO, KHPT.
The KHPT project staff encourage active community involvement and through patient support group meetings improve the coverage of vulnerable populations like tribals, migrants, and mine workers. The approach has been a tremendous success in supporting increased case notification and improved successful treatment for both drug-sensitive and resistant TB.
“The support from the counsellor helped me discover and speak to a TB survivor when I was down. He encouraged me and supported me to complete the treatment through a Starter Kit, which was very useful,” said Shankar from Sangareddy industrial belt. Armed with a TB Mukt certificate, he was able to convince his supervisor and got his job back.
The expected project outcomes are to develop and scale up effective behaviour change operational models that improve coverage of vulnerable populations and to log increased case notification, and improved successful treatment outcomes in DR TB.
