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Tuberculosis

TB – Prevention and Care

India accounts for the world’s highest TB burden country with 23% TB affected people. TB is one of the major public health problems in the country. In-sufficient infrastructure, unreached population, migrations, myths and different health seeking behaviour are the key challenges in addition to availability and access to preventive, curative and informative TB services.

GLRA India is providing substantial support to National TB Program through its 15 partner NGOs covering a population of 30 lakhs in 11 states. GLRA partners offer services such as TB treatment unit, sputum examination, diagnosis, & treatment, contact screening, sputum collection & transportation besides spreading TB awareness through social mobilization campaigns. An overall 82% cure rate is reported among TB patients who received treatment from our partners.

GLRA India has initiated innovative projects  such as TB contact (house hold & social) screening in Kochi, Kerala, MDR TB home based care projects in Delhi & Jaipur and E-compliance treatment adherence project in Jaipur slums. GLRA is a sub-recipient of Global Fund Round9 TB ACSM projects in West Bengal – Axshya India until September 2015 and also part of the New Funding Model (NFM) projects in 9 districts.

Our Latest Work

GLRA at a glance: GLRA India has vast experience in the field of TB having partnered with Global Fund Axshya India ACSM Project, USAID- supported IMPACT Project, provides support to 20 NGO Partners working on TB across 11 states, implements innovative projects like Home Based Care for MDR TB patients in slums of Jaipur and Delhi, TB control among Prison inmates in Gujarat, E-compliance projects in Jaipur and TB among truckers in Delhi, among others. GLRA India has been an active partner in the control of tuberculosis in the state of West Bengal for the past 10 years through several projects involving active case search, capacity building, engagement of non-qualified private providers, notifications and novel initiatives such as Silico-tuberculosis and prison TB.

  1. DRTB Project – Sikkim

Gangtok have four TUs — We are working in two TUs (Gangtok & Singtam TU)

  • Periodic home visits by trained counselors to provide counseling during treatment.
  • Provide early identification and appropriate referrals in case of drug side effects
  • Undertake family contact tracing
  • Provide counseling and appropriate linkages to address co-morbidities such as diabetes mellitus, smoking, and alcohol use.
  • Provide nutrition supplement to patients BMI below 18.5.
  • Patient Provider Meeting once a month.
  • Undertake school-based IEC programs.

To contribute to reduction of default rates among MDR TB patients by facilitating access to quality MDR treatment services through home-based care and support.

  1. Home Based Care and Support to MDR TB patients – New Delhi

Project aimed at improving early initiation of MDR TB treatment by contact screening, case holding through counseling at home, reduce Loss-to-Follow up by 3% of the baseline (22%), early identification of adverse reactions and referral, infection control measures at patient and family level, family counseling on nutrition practices, and development of standardized modules and other learning materials. The project is being implemented in New Delhi.

  1. Project DISHA – Distinctive Integrated Sustainable Health Action

A  CSR initiative OF Apollo Tyres, is being implemented in close collaboration with ATF (Apollo Tyres Foundation) in Sanjay Gandhi Transport Nagar in Delhi. It is one of the first TB projects in the world that is targeting a highly mobile population group. The project catchment falls within RNTCP BJRM district and therefore is regularly reviewed by State TB Office and NDTB Control Unit. Its aim is to sensitize Truckers (truck drivers and helpers) and allied (local shopkeepers, dhaba owners and others) population about general health and hygiene and TB. DISHA and its new phase Nai DISHA are identifying presumptive cases and referring them for free sputum and X-ray screening or CBNAAT examination.

4. Project NAI DISHA – New DISTINCTIVE INTEGRATED SUSTAINABLE HEALTH
AND ACTION

NAI DISHA, a comprehensive project by GLRA India, aimed at promoting health among truckers, helpers and allied population in the Transshipment locations (TSL’s) of Lucknow, Agra and Jaipur in North India. With 6 million trucks in India, the trucking Industry contributes 4.5 – 5 percent to the national GDP. Despite being the most economically productive labour force in India, the pilots of the India logistic system are
leading a miserable and marginalized life. Majority of truckers drop out of schools joins as a helpers and later become truck drivers. A big majority of them drive continuously for long hours without adequate food and
sleep/rest. Lack of adequate sleep, consuming food at unhygienic eateries and driving continuously for 400 – 700 km every day, adversely affect the health of truckers and put them at risk of Tuberculosis (TB).

The truckers are a high risk group, visit sex workers often due to factors like time away from home on the road, marital status, alcohol use, low income level etc. As per UNAIDS Gap Report 2016, 2.6% of two million
truckers are living with HIV and are at higher risk of developing TB (26 to 31 times) than those without HIV infection. The Incidence rate for TB is 204 (140–281) according to Global TB Report 2018. Lack of awareness on preventable infections / diseases or personal hygienic further adds to their vulnerability.

Realizing the urgent need for addressing the health challenges of truckers, GLRA India’s NAI DISHA is a timely two-year intervention in collaboration with diverse stakeholders such as government, transport associations, health functionaries and others in Uttar Pradesh and Rajasthan.

GLRA India in collaboration with Apollo Tyres Foundation (ATF) and RNTCP implemented the first phase of DISHA from January 2017- March 2019 that focused on early detection of TB among the truckers & allied
populations in New Delhi’s Sanjay Gandhi Transport Nagar. This is the first project in the world that focused on TB amongst truckers. Based on the learning from the previous phase, GLRA India, DB Foundation and BEH (Bündnis Entwicklung hilft)- are collaborating to implement project NAI DISHA, which is a replication of the previous phase to cover three other destination TSLs namely Jaipur, Agra and Lucknow in North India.

As per WHO, 200 – 299 new TB patients are expected per 100,000 general Indian population. With these estimates, it is expected, about 12000-18000 TB patients may occur annually in 5-6 million Indian truckers’ population. Due to high HIV prevalence among truckers the absolute number of TB cases may be even higher.

Key Activities

  • The project team conducts routine outreach activities, follow-up with presumptive/ patients, maintenance and validation of digital records, documentation and mobilization of the truckers/helpers to seek diagnosis and treatment for TB through linkage with the health system.
  • Different community outreach approaches like group meetings, one to one interpersonal interaction with truckers and labourers, community meetings at dhabas/eateries, active surveys,street plays and health awareness camps will be used.
  • Awareness raised on general health and hygiene & preventive measures other than TB.
  • The TB messages on hoardings/ banners with contact numbers of referral centres for seeking TB related services displayed at major eateries (dhabas), fuelling stations and mechanic/tyre repair shops along the most common routes in and out of the target TSLs.
  • The project activities, coverage and quality is being monitored online through web-based mechanism, telephone and through on-site random physical validation by the Project Management Unit.

Project outcomes will include: truckers and allied population sensitized, presumptive cases referred/screened, confirmed TB cases, loss to follow up reduced, treatment outcome rates improved, in addition to other essential process / output indicators to monitor the project and thus an overall improvement in the quality of
life of the target population.

Case Studies

Karuna Kumari, an enthusiastic girl from a small slum of Shastri nagar, New Delhi is an enthusiastic young girl who suffered from TB for several years and got treated with the help of GLRA, India.

Where a family of 5 lives in one room in that slum, Karuna  has always been supported by her mother for studies and career, but also on the other hand the sanitation and hygiene were not taken care of since long due to which Karuna got infected with the bacteria of TB, Karuna after a year got completely out of TB but left her infection in her family which affected her father. Now her father has TB and he is also getting medically treated with the GLRA.

Also, with the help of GLRA, Karuna took a diploma course of beautician and qualified successfully. Now apart from her studies, she works as a freelance beautician and earns for family and herself.

Karun’s mother has been the biggest pillar to family and motivated her at every point of life to study and have bright career. She is thankful to GLRA for such amazing assistance with the passage of time.

Himanshu Rana, one and a half year old toddler is not even aware that he is suffering from MDR TB and is the youngest child enrolled in GLRA’s ‘Home based care and support for MDR TB patients’ project. Since the unfortunate death of his parents due to TB, his mausi(Aunt) has been taking care of him. He was only two months old when he lost his mother and his father passed away in September 2017. They both were taking private treatment and however his father was a defaulter. His family originally belongs to Nepal, however they shifted to India nine years ago. He is the only child of his parents. Likewise his parents, he was also on treatment from a private doctor for 4 months, however when his condition did not improve then his treatment was started from Pt Madanmohan Malviya Hospital (government hospital) chest clinic from November 2017. At present, his weight is 9 kg.

His mausi(Aunt) shares that, she finds it difficult to give him medicines as he vomits immediately after its intake. Medical doctors and GLRA counsellors, guide her as how the medicines can be mixed with the food so that he does not vomit. The child gets the love and care from his mausi (Aunt) and her husband. His mausi(Aunt) is a housewife and her husband is a driver and they live in a rented space in Sangam Vihar. Hence, GLRA supports for his nutrition by providing milk and ‘pediasure’ on monthly basis and happily, the child has started showing improvement. His mausi(Aunt) says he has even become active now.

Lala Ram is a 51 year old man who makes truck parts in Sanjay Gandhi Transport Nagarand earns an average of Rs 15,000 a month.  He has been working here since its inception.  He has no education and can only sign.  He lives in a rented space in Haiderpur with his family which consists of his wife and five children.  He originally hails from Uttar Pradesh.

He says that it had been more than two weeks that the fever was recurring in evening, then the cough and ultimately cough and severe sputum.  He opted for private treatment where he spent around Rs 13,000 for various medical tests referred by the doctors however he was not getting any relief.   He says, that his condition was constantly deteriorating, then one day he watched a street play on TB awareness which was organised by GLRA outside his shop.  He realised that he has TB symptoms and after the play contacted GLRA team for support.  GLRA counsellor referred him for X ray and sputum examination.  Though his X ray was suggestive, however his sputum result was negative.  Therefore, the Medical doctor of BabuJagjivan Ram Memorial Hospital chest clinic advised for CBNAAT which came out to be microbiologically confirmed TB.

He says that he had never heard about TB earlier, however due to the awareness created GLRA he has now uses infection control method by using a mask or cloth and washes it regularly.   His family is supportive to him in his medical condition.  He regularly takes DOTs from office premises.