Tuberculosis

 
Promising Practices in Health Care  
   

* Sputum Collection Centres

   

* Strengthening the response to MDRTB through Public Private Partnerships

 

Introduction:

Tuberculosis, or TB, caused by Mycobacterium tuberculosis is an infectious disease that commonly affects the lungs. However, TB can occur in any anatomical site of human body including neck glands, spine, bone and joints, meningitis, kidney and genitor urinary system. The infection is transmitted from person to person by droplet infection from active lung TB patients. Symptoms of active TB include coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats. Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year which continues the transmission. Overall, one-third of the world’s population is currently infected with the TB bacillus. 5-10% of people who are infected with TB bacilli (but who are not infected with HIV) become sick or infectious at some time during their life. Among people living with HIV, the chances of developing TB are 55-60% during their life. The risk for developing TB disease is also higher in persons with diabetes, other chronic debilitating disease leading to immune-compromise, poor living conditions, tobacco smokers etc.

TB facts and figures* (Source-RNTCP Annual Report-2011)
Globally there are around 9.4 million TB cases and 1.3 million TB deaths. Africa region reports the highest incidence, prevalence and mortality rate, although South East Asia has the highest in terms of absolute figures, contributing 35% to the global TB incidence. In India around 2 million TB cases are reported annually with 1.7 million infectious cases and a total prevalence of 3.8 million.

LEPRA India’s foray into Tuberculosis Control Programme
More than two decades of dedicated service to persons affected by leprosy through direct participation in leprosy projects, support to NGOs working in Leprosy and support to government MDT district projects has helped us to make inroads into leprosy and related problems of other communicable diseases of public health importance.
LEPRA India’s participation in Tuberculosis control programme has been justified by a combination of factors: The expertise that has been built in the field workers all through the years needed to be channelized. Also the reappearance of TB as epidemic and the similarity in diagnosis and need of regular treatment in both TB and Leprosy warranted participation in tuberculosis control programme. In addition, field level education and counselling that LEPRA India is equipped to utilize to create an impact on allied areas like TB and HIV/AIDS.

Approach

LEPRA India’s Participation in TB control programmes is in five different ways:
  1. Direct participation in TB control

  2. Capacity building

  3. Advocacy, Communication and Social Mobilization (ACSM)

  4. Research activities – Field / laboratory

  5. Publications

Beginnings

In March 1996 a joint leprosy/TB/AIDS awareness programme has been taken up as a pilot study, in a part of Jeypore sub-division, covering a population of 2.61 lakhs.

The main objectives were to devise an appropriate strategy for implementation of a joint programme by involving the staff of PHIs and Anganwadi workers in the implementation of DOTS. In the pilot study 263 sputum cases were treated with 87% cure rate.

Further….

  • Since 1998 the treatment of TB patients has been done in the pattern of RNTCP by utilizing the general health care staff. TB medicines are procured from DANTB. Since 1999 the programme has been extended to entire Jeypore sub-division covering 5 lakhs population. 1368 TB cases were treated until launching of RNTCP in the district. 86% cure rates are achieved.
  • Sputum Microscopy and DOTS components have been established in projects and routine IEC activities under the Revised National Tuberculosis Control Programme (RNTCP) like sensitizing community and private health providers about DOTS and RNTCP have been undertaken. The District TB control officers in AP, Orissa, Bihar and MO requested participation of LEPRA India projects in RNTCP since 2001. The main areas identified was to establish and implement designated microscopy centers (DMCs), Sputum collection centres (SCCs), Tuberculosis Units (TUs), LT scheme and Culture & Drug Sensitivity Testing (C&DST) NGO schemes under RNTCP.
Profile of LEPRA India direct service initiatives under RNTCP NGO signed schemes

Year of implementation of RNTCP

Schemes implemented

Name of the Project

Coverage population (in Lakhs)

No. of DMCs /TU/ districts covered

2001

Scheme 4

BPHRC

1.1

1 DMC in Rangareddy

2002

Scheme 4

UMEED

5.9

5 DMCs in Hyderabad urban areas

2003

Scheme 4

Koralep

0.6

1 DMC (tribal)-Koraput

2003

Scheme 4

ARTH

2.5

6 DMCs in Tribal areas till 2010 in Adilabad, AP

2003

Scheme 4

JUNLEP

0.6

1 DMC

2004

Scheme 4

KRISCHIP

2

2 DMCs in Vijayawada urban areas

2005

Scheme 5

ARTH

4.7

1TU at Narsapur G, Adilabad rural areas

2006

Scheme 4

BiHAP

1.4

1 DMC in urban Munger

2007

Scheme 9

Koralep

3.7

1 TU in Malkangiri

2008

Scheme 9

BiHAP

11

2 TUs in Singhia in Samastipur and Katoria in Banka

2008-09

S-5 LT scheme
S-2 Sputum collection centres

MP
MP
Odisha

2.5
4
13

4 in Buniyad / Arogya
10 in MP projects
180 in Koraput, Odisha

2009

S-6 Culture & DST

BPHRC

170

4 coastal districts in AP

2009-10

ACSM*

Axshya TB India project
(A GFATM Rd 9 supported project)

186
141

8 districts in Odisha
11 districts in MP

*not under signed RNTCP schemes for NGOs

 

LEPRA India geographically covers in providing direct TB services to 5.3 million populations in 4 states namely AP, MP, Odisha and Bihar, ACSM activities in 32.7 million MP covering 19 districts of Odisha and MP together and DOTS Plus CDST activities in 17 million covering 4 coastal districts in AP. The direct services cater to the Hard to reach/needy areas in rural, tribal and urban population. The sputum collection centers improve access. TB HIV co-infection addressed by integrated work of ICTC and DMCs and introduction of ORWs to enhance TB and HIV cross referrals. Introduced Patient friendly services with enabling atmosphere and Patient Charter are translated in Oriya, Hindi and Telugu. The data review and management is done by analysis of performance indicators and review of performance and progress of DMCs/TUs on periodical basis. In the intervention areas focus is to mobilize the local communities and stakeholders to enhance the TB related awareness.

 

Some of the best practices initiated:

The performance indicators in 2010 are the annualized case detection rate was 149/lakh per year (target is 142/lakh/year) with new sputum positive case detection at 60%. About 5694 TB cases were diagnosed and initiated on DOTS and followed up. From the above, 396 new sputum positive cases were diagnosed among 4129 TB suspects examined from the 190 sputum collection centres situated in Odisha and MP. The sputum conversion rate was 89–94% (target is 90%), treatment cure rate was 82 – 92% (target is 85%), death rate was 3-7% and defaulter rate was 3-6%. In 2010, TB HIV cross referrals increased and for this involvement and coordination with TIs of FSW, MSM, IDU and PLHA was established. About 527 TB-HIV cases were managed during the year. In AP 12 new MDR TB cases were diagnosed and put on Cat IV treatment, for which our staff support in treatment adherence.

Capacity Building

About 680 local private health care providers in the DMCs/TUs were sensitised and involved in referrals of TB suspects and in provision of DOTS. Capacity building activities in TB was provided to PHC/UHP staff and TB sensitization for involvement was carried out with local private health care providers (680), DOTS providers (3170) and target groups like self help groups, youth clubs, AWWs, village volunteers, tribal leaders, teachers, students, local NGOs/CBOs/FBOs and village tribal development members.

Community awareness programs like film shows, group meetings, observation days, folk art /stage plays by local artists. Supported the DTCS in implementing tribal action plan and participated in monthly and quarterly review meetings with concerned staff and DTCS. Provided support to DTCS in implementing awareness programmes with LEPRA IEC vans.
LEPRA India is the NGO member in the District TB Control Society and State TB Control Society in the implementing states and districts.