World TB Day: Communities at the heart of BTB project with a mission to end TB

New Delhi, Mar 23: Shankar works in the mines in the industrial belt of Telangana. He could not take medicines openly in front of his fellow workers during his shift hours for fear of losing his job. He became irregular in consuming his TB medicines and soon fell sick and lost his job. But ahead of the World TB day Shankar is back to work, thanks to the TB mukt certificate.

As India observes World TB Day, it is a stark reminder that lack of adherence to medicines not only makes persons with TB susceptible to drug-resistant strains but increases the financial public health burden on the curative process.

Even as we recover from the COVID-19 pandemic, TB remains one of the world's deadliest infectious killer. India has the highest TB burden in the world and an estimated 27 lakh TB cases in 2020 (WHO).

The theme of World TB Day 2022, 'Invest to End TB. Save Lives' conveys the urgent need to invest resources for both prevention and cure, to ramp up the fight against TB. Working closely with the Indian government's ambitious National TB Elimination Programme (NTEP), Breaking the Barriers (BTB) project, uses community engagement as a central ploy in accelerating TB elimination.

Care and support for TB persons is critical to help them consume medicines regularly for the prescribed period. Several patients are very irregular and do not take TB drugs resulting in an increased treatment period and also makes patients susceptible to drug-resistant TB. "Investing in behavioural change and establishing social support systems for TB persons and Caregivers through active community involvement helps improve adherence among vulnerable groups. It will reduce future financial burden by effectively preventing new infections," said Dr. Rehana, Project Lead, BTB, on the eve of TB Summit organised by the Central TB Division here on Thursday.

The KHPT project staff encourage active community involvement and through patient support group meetings improve the coverage of vulnerable populations like tribals, migrants, and workers in tea gardens and mines. The approach has been a tremendous success in supporting increased case notification and improved successful treatment for both drug-sensitive and resistant TB.

A Shankar in Telangana or a Laxmi in Belagavi (names changed) are not isolated cases. "The support from the counsellor helped me discover and speak to a TB survivor when I was down. He encouraged me and supported me to complete the treatment through a Starter Kit, which was very useful," said Shankar from Sangareddy industrial belt. Armed with a TB Mukt certificate, he was able to convince his supervisor and got his job back. KHPT is implementing the BTB project in Karnataka, Telangana, Assam and Bihar using innovative tools like Mukt Certificate, starter kit, TB buddy, Health auto to involve community and cater to the social aspects that challenge persons with TB.

During the peak of the pandemic, Laxmi was diagnosed with TB and initiated on treatment in Maharashtra. "My husband was alcoholic and abusive when I was diagnosed as a TB patient and I even sought for divorce to escape the mental abuse. Due to stigma in my husband's home, I was forced to relocate to Belagavi with my school-going children," said Laxmi, who faced grave challenges at a personal level and discontinue her treatment. However, the support from the community structures which includes ASHAs, Anganwadi workers and SHGs, created by the project and a TB buddy help install confidence and support patients with the treatment.

The story of Anand who lives alone in a remote farm house in Ballari district is similar. He is aged and he suffers HIV co-infection and needs to take a lot of medicines. "Sometimes, I am lonely and depressed. I have to take many tablets. But my brother takes care of me," said Anand, who found solace in community structures that have helped his brother be his TB buddy and support his treatment. The project reaches out to vulnerable communities who live alone or who are 60 plus.

"At KHPT, through the BTB project in four states, we have found that investing in vulnerable communities and building their capacities has empowered them to create a safe environment that enables recovery for persons with TB. Community participation is a core component of all our programmes," said Mohan HL, CEO, KHPT.

BTB project is run in 87 TB treatment units in 15 districts reaching out to a vulnerable population of over 10 lakh in Assam and Bihar and over 34 lakh in Karnataka and Telangana.

(Some names of persons with TB were changed)