A useful pilot project: for detecting HIV-TB among at risk populations

[Guest guest]

“THE AT-RISK POPULATION WITH HIV-TB CAN BE DETECTED IN LOW COST INTEGRATED

APPROACH.”

Dear friends,

The following happened 2 years back when I was working as the Technical

Specialist of CARE India's one of prestigious HIV prevention program conducted

in 22 cities of the 5 highly vulnerable states of India.

During one field visit of mine in Agra, Uttar Pradesh, India I met some female

sex workers in a brothel site who strongly demanded to provide them TB services

because quite a few of them had been suffering from TB at that time and paying

huge money from the treatment. They did know there is free treatment facilities

with the govt, but they had no idea how to avail that facility due to poor

access to proper information.

On the basis of that observation we did a small pilot project in Allahabad, UP

which was named " Scaling up of TB services in the Targeted HIV/AIDS

Intervention Programs among the vulnerable groups – a pilot project in India "

Let me describe it in the following fashion:

Objective: People of vulnerable groups (Sex Workers, Migrants, and

Truckers) in India are prone to TB (along with HIV) due to over-crowded living

condition, low socio-economic status and poor accessibility to information and

services coupled with ignorance, stigma, and discrimination. This enhances TB

load and HIV-TB association in these groups.

We performed this pilot to demonstrate scaling up of TB services in

cost-effective manner within vulnerable groups of a city located in a highly

vulnerable state of India, through existing targeted interventions by local NGOs

designed for HIV prevention among vulnerable groups. The estimated number of

population at risk covered: SWs 117, Migrants 4000, and Truckers 5525. Duration

of pilot: 6 months. There was no funding support to do the pilot study.

Methods: 16 NGO workers, 151 Peer Educators working with TI projects of 2 local

NGOs were trained on TB and National TB Control Program by

District TB Office in collaboration with District HIV/AIDS Officer.

The vulnerable groups were regularly given critical information on TB, DOTS,

HIV-TB, sputum Microscopy Centers (MC) along with messages of HIV/AIDS through

existing NGO led outreach and peer programs, BCC events, audiovisual shows.

Regular screening was done in the field for TB positive symptoms. NGOs also

strengthened linkages between local VCT and MCs.

The district and health administrations were sensitized to consolidate

district level HIV-TB collaboration. NGOs had no extra expenditure.

The whole process was conceptualized, initiated and facilitated by us, being

representatives of an international NGO.

Result: 76 sputum positive cases detected by NGO staffs and PEs in 6

months (13 SWs, 24 Migrants, 8 Truckers, 31 from adjoining opulation).

They were treated by district TB control program free of cost. DOTS provided by

trained PEs and followed up. There was 10-20% increase of cross referrals

between VCT and MC. 10 persons from at risk population detected with HIV-TB and

referred to higher centers.

Conclusion: The at-risk population with HIV-TB can be detected in low

cost integrated approach. It can also help to reduce TB load among vulnerable

and adjoining population by increasing accessibility and

availability of TB control services and information. This has further impact on

HIV-TB association among the high risk groups with a successful TI program

facilitating HIV prevention.

Unfortunately we could not scale it up in other places to integrate

with TI program because of stoppage of the main HIV prevention project.

If anyone of you wants to know more about this pilot don't hesitate to

contact me. (Incidentally the abstract above was also selected in the recent

ICAAP8 held recently in Colombo)

Best Regards,

Sugata

Dr Sugata Mukhopadhyay

Email: sugataids@...