TB remains one of the world’s biggest threats. As per WHO report, in 2016 alone, 10.4 million people are estimated to have fallen ill with TB and 1.7 million died. Over 95% of TB deaths occur in low and middleincome countries. Multi drug resistant TB (MDR-TB) remains a public health crises and a health security threat with 490 thousand MDR-TB cases. As per the Global TB report 2017, the estimated burden of TB in India was approximately 28.00.000 accounting about quarter of the world TB cases. Government of India has set the goal of ending TB in India by 2025. Tackling TB in India requires both strengthening the public sector, as well as engaging with the private sector and civil society organizations. GLRA India provides support to RNTCP schemes through 11 NGO partners covering 2.5 Lakhs population in addition to multiple direct projects. In case of Multi- Drug Resistant Tuberculosis (MDR TB), when the patient has to take the treatment for two years, there is possibility of increased default rate amongst the patients. Hence, to curb this GLRA came up with ‘Home based care and support to MDR TB patients’ project in Delhi’s four chest clinics of government hospitals to promote treatment adherence support to MDR TB patients and their immediate caregivers at their home through counselling. Patients who lost to follow up during pre-treatment are traced and their treatment initiation is facilitated. Needy MDR TB patients and their families are supported through socioeconomic programme to promote income generation and vocation trainings. Patients who have low Body Mass Index (BMI) are provided monthly nutrition support for six months to maintain their nutrition level. Out of which 54% are women, 42% are men and 8% are children (below 14 years of age). The major components of the project are:
- Counselling –to patient and its family
- Promote infection control – use of mask, provided pedestal fans for better air flow
- Socio-economic support – income generation and vocational training (The main focus is on reaching out to Below Poverty Line (BPL) families)
- The disease is often associated with high stigma due to the fear of spread of infection. Most of the patients are underweight with a BMI of less than 18.5 resulting from inadequate nutrition, as most of them lack adequate nutrition due to their poverty. Further, majority of MDR TB patients suffer from poor appetite which often leads to patients taking inadequate nourishment. Such patients often require continuous psycho-social counseling to ensure treatment adherence. Therefore, along with counseling, we provide continuous macro nutrient supplements through their treatment cycle as such a support to underweight may also contribute to improved drug adherence and thus better treatment outcomes while accelerating their recovery process.
- IEC activities – group meetings with patients and healthcare providers, and TB awareness among school
In the year 2017, 226 MDR TB patients were enrolled in the project and they were counselled and supported by the team of counsellors posted in each chest clinic. Neighbourhood contact survey of 7,850 households was conducted which helped to identify 537 presumptive TB cases. Out of which 311 underwent diagnosis which led to 17 TB confirmed cases and were then put on DOTs treatment.