Focus on Integration

PSI’s tuberculosis (TB) programs seek to strengthen the role of the private sector in reducing TB incidence and ensuring successful TB treatment completion.

In countries with a high TB burden, PSI uses advocacy, communication and social mobilization to promote TB awareness, reduce TB-related stigma, increase care-seeking behaviors, and provide services and referrals for TB diagnosis and treatment. In addition, PSI promotes the Three I’s to decrease TB burden among people living with HIV by: strengthening Infection Control in health care settings, providing referrals for Isoniazid Preventive Therapy; and, Intensified Case Finding through HIV counseling & testing (HCT) networks. Finally, PSI offers HCT to people with TB.

CONNECTING THE DOTS: PREVENTING AND TREATING TUBERCULOSIS IN INDIA

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 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.

ADDRESSING THE TB BURDEN IN PAKISTAN

Ghulam Mustafa is a 45-year-old man from Karachi. Recently, he began experiencing night sweats, weakness, a painful cough, fever and weight loss. As his symptoms worsened, he saw many doctors, none of whom cured his illness.

One day, Ghulam attended a Good Life tuberculosis orientation, organized by PSI’s affiliate Greenstar Social Marketing with support from the Global Fund to Fights AIDS, Tuberculosis and Malaria, where he realized that his symptoms matched those of TB.

After the meeting, Ghulam met with the community health organizer, Yasmeen, about his condition. Yasmeen counseled him and referred him to the Greenstar Good Life TB provider’s clinic, where a sputum test and chest x-ray confirmed Ghulam had TB. Ghulam is one of the approximately 1.5 million people living with TB in Pakistan.

Ghulam worried about the cost of treatment since he was the sole breadwinner for his family. But Yasmeen assured him that Greenstar Good Life TB team would provide free TB medication at his house until his TB was cured.

During one of the Good Life team’s visits to Ghulam’s home, they identified the same symptoms in his two daughters and wife and referred them for diagnosis. They all had TB. But Yasmeen and the Good Life team explained how his family would be cured and how they would be protected from spreading TB to others.

Through Greenstar Social Marketing, about 36,000 community-based treatment supporters, like Yasmeen, have been trained to support and monitor patients throughout their Directly Observed Treatment, Short-course (DOTS). More than 40,000 TB patients have been registered with a treatment success rate of 91 percent under the TB program, contributing to about 39 percent of the case detection rate nationally.