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Accelerating Active Case Finding of TB Patients in India

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Accelerating Active Case Finding of TB Patients in India



Stigma remains a barrier to seeking tuberculosis treatment for some.
Dr. KK Chopra, a former director of the New Delhi Tuberculosis Center, India State TB Training and Demonstration Center, recently emphasized the importance of accelerating active case finding (ACF) to end TB.
Speaking at a TB stakeholders’ meeting in Goa, Dr. Chopra stressed the need for systematic identification of people with presumptive active TB, using rapid tests, examinations, or other procedures.
Truenat a chip-based, point-of-care, and rapid molecular test for diagnosis of infectious diseases like tuberculosis (TB) and COVID-19, developed and manufactured by Molbio Diagnostics, was endorsed by the World Health Organization (WHO) or initial diagnostic tests for pulmonary tuberculosis and rifampicin resistance TB in January 2020.
Truenat is portable and battery operated, bringing diagnostics to the community.
The test results are available in about 1 hour, making it a rapid and accurate tool for TB diagnosis.
Dr Chopra spoke of the risk groups and the steps to be taken. He highlighted the risk areas and what is required to mitigate the spread of TB.
“People living under the same roof with a TB patient are exposed. A patient is infectious before commencing treatment,” said Dr Chopra.
When one is diagnosed with TB and is placed on treatment and with the treatment working well, one is no longer infectious. However, household contacts and close contacts of active TB patients are required to be screened for TB.

“People living with HIV and not virally suppressed have a weak immune system, they to need to be screened at each health facility visit when they go for drug resupply.
“Miners and current and former workers in workplaces with silica exposure have a high risk of developing tuberculosis,” said Dr Chopra.
He stated that epidemiology surveillance is important as risk can be to groups.
“Screening in other selected risk groups can be considered after a careful assessment of epidemiological relevance, health system preparedness, and risks and benefits for the individuals in the affected areas,” he said.
He also called for ACF for people living under difficult conditions.
“People living in slums, prison inmates, old aged homes are compromised and are at high risk of TB infection. The elderly by nature, have weaker immune systems, making them prone to infections too. Construction site workers, refugee camps, night shelters, the homeless, orphanages, homes for the destitute, and asylum camps are all at high risk of contracting TB,” said Dr Chopra.
An area known to house sex workers in India was noted to have a high incidence of TB.
“GB Road has 32 brothels, 2500 regular sex workers, and 96 work rooms.
In a mobile screening program taken in Delhi, from 23 December 2021 to 19 September 2022, a total of
3924 and 2154 were screened. The total symptomatic was 465. A total of 2154 had an X-ray done. The total number diagnosed with TB was 175, with 81 clinically diagnosed and diagnosed 94 microbiologically diagnosed,” said Dr. Chopra. The figures show the need to bring health services to a vulnerable community.
The key population covered were female sex workers operating along the GB Road area.
Stakeholder involvement is important, and good relationships with community based organizations have seen success in most health programs taken to the people.
It is easier for the community to welcome people they are already familiar with them.
“An NGO working in the field of HIV/AIDS that has been involved accompanied the outreach workers from the districts and were trained to identify TB symptomatics through house-to-house surveys

“Staff from Area Chest Clinic attended the training. They were taught how to initiate patients on treatment. Staff from NGO as well as outreach workers, including peers working in GB
Road areas were trained to identify chest symptomatic.
“If a person was found with TB
symptoms, the outreach worker noted the details, and one sputum sample was collected.
“Before screening, educative and informative activities were conducted in the area. The team had to ensure that sputum sample was collected. If sputum tested positive, the patient had an X-ray taken if positive treatment was commenced without wasting time,” added Dr. Chopra.
Overall, 6% TB cases were found among those screened.
The World Health Organization (WHO) recommends the following thresholds for TB testing
for coughing patients:
5% or more of patients with cough of any duration: TB prevalence is considered high
2-4%: TB prevalence is considered moderate
Less than 2%: TB prevalence is considered low
For non-coughing patients (e.g., household contacts, HIV+ individuals):
2% or more: TB prevalence is considered high
1-1.9%: TB prevalence is considered moderate
Less than 1%: TB prevalence is considered low
With 6% of tested people being diagnosed with TB shows that the population has a high burden of TB.

Meanwhile, back home in Zimbabwe, community health workers are the eyes and ears in the public health response nationally.
Itai Rusike, the Executive Director, Community Working Group on Health (CWGH), a community based organisation that directly works in primary health focusing on prevention said if we talk of treatment, we would have missed the prevention pillar.
“Village Health Workers (VHWs) can be the glue that connects our healthcare system to communities. They are critical to health promotion, disease prevention, early diagnosis and referral, and helping people to stay on treatment and stay healthy.
“For VHWs to be effective, they should be empowered through trainings. They must be treated with respect and this requires political commitment to support them with incentives such as bicycles, uniforms, consumables and allowances from the national budget in order to enhance their work and motivate them instead of the current situation where they rely on external partners for support.
“Since VHWs live in the same community they serve, they experience the same social, economic and environmental living conditions and they are always the first to know if there’s any disease outbreak in their community as they have direct interface with the people.
“We need a more transparent recruitment process that ensures that VHWs come from the area they live in. Ideally, members of the community should be part of the selection process. As VHWs retire, die, or leave for other reasons, new CHWs should be recruited promptly,” said Rusike.
Rusike called on these cogs in the health delivery wheel to be employed by the parent ministry.

“All VHWs must be employed by the Ministry of Health and Child Care. Their allowances and training must be standardised and paid by the government, with donors coming in to complement the government efforts. At the moment, there is no standardization of payment of allowances as some VHWs are paid by the Global Fund whilst others are paid by the Health Development Fund causing a lot of tension amongst the VHWs as some are paid their allowances on time with others not being paid on time.
“The present ratio of VHWs per population needs to be increased as there are approximately 14 000 VHWs in the country out of a national need of about 30 000, straining the ones at work,” urged Rusike.
“VHWs also need protective gear for the weather and protective equipment (PPE) against diseases such as TB and Covid-19.
“VHWs needs the support of inter-sectoral body, which includes various community structures, as such health outcomes depend on other sectors and community participation. When we talk of treatment of diseases that can be prevented, it means our prevention needs strengtheing,” said Itai Rusike, Executive Director, Community Working Group on Health (CWGH).
Primary health care is centered on prevention, a dignified allowance ought to be given.

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