Connecting the Dots

Ashwini, an 18-year-old garment worker in Bangalore, contracted tuberculosis (TB) several months ago. Factory workers like Ashwini tend to be at high risk of TB infection due to overcrowding and poor ventilation in their working and living spaces.

It was on the job that Ashwini met members of PSI’s Project Connect. With funding from the U.S. Agency for International Development, Project Connect conducts a workplace program on HIV/AIDS and TB. As part of the program, PSI’s interpersonal communication (IPC) agents conduct one-on-one sessions on TB awareness, symptom recognition, and treatment counseling. IPC agents screen clients and refer any worker experiencing chronic cough, fever and other TB symptoms for testing to the nearest Designated Microscopy Centre, which is affiliated with India’s Revised National Tuberculosis Control Program (RNTCP). At the center, the client is tested for TB, and those who test positive immediately start treatment.

Ashwini, along with 13 of her colleagues with TB symptoms, was referred to the nearest diagnostic center where she tested positive for TB. She first underwent counseling on the importance of treatment adherence and then began Directly Observed Therapy Short-course (DOTS) treatment. DOTS is the internationally recommended strategy for TB control. In the DOTS strategy, the treatment is given under direct and supportive observation to ensure the right drugs are taken at the right time for the full duration of treatment.

PSI’s Project Connect program has worked to create local understanding and awareness around TB within the garment worker community. In addition to counseling, IPC agents work with company management to ensure that suspected TB positive clients are given permission to visit the diagnostic center for treatment and follow-up appointments during office hours.

In India, strong partnerships among the National TB Program and the Ministry of Health and Family Welfare, local nongovernmental and community-based organizations, and the private sector are proving key to moving toward global targets to reduce TB burden in the country.

Local organizations and the government have worked together to create new TB policies which are supported by programming that seeks to change provider and client behavior. And the private sector is increasing its role in the efforts.

India has the largest private health sector in the world. Data suggests that 6 percent of all patients referred for TB diagnosis and testing 1 are referred by the public sector, whereas up to 80 percent of outpatient care is provided by the private sector. PSI/India works with private providers to strengthen TB service delivery.

In Ashwini’s case, the nearest TB treatment provider was more than five kilometers away. Since she needed treatment every day, she was worried that she wouldn’t be able to adhere. PSI worked with factory management and the RNTCP to place a treatment provider on the company premises.

PSI is also including public and private providers in trainings, and involving local communities by facilitating the creation of TB clubs in rural areas to reduce stigma against the disease.

Ashwini is now in her last month of treatment, and she is scheduled for a final test soon. She is among hundreds of other garment workers currently accessing counseling and DOTS treatment services. “If TB-infected people get the same type of support that I received, we can definitely stop TB,” she said.

- PSI Author: Katie Wallner, Consultant, Sexual, Reproductive Health & TB, Washington, D.C., and Project Connect team, India