Asha’s Tuberculosis Disease Management Program
India accounts for about a fifth of the world’s tuberculosis (TB) burden.
Tuberculosis Among Slum Dwellers
India accounts for about a fifth of the world’s tuberculosis (TB) burden, with an estimated 2.2 million new cases and some 300,000 people dying from the disease every year. Of these, an estimated one million cases annually go unreported, each one potentially infecting 10 to 12 others. In recent years, a dangerous new variant has emerged – the deadly multi-drug resistant strain of MDR-TB, much harder to diagnose and treat. And an even more virulent strain, extensively drug-resistant (XDR-TB), which does not respond to most known drugs has been reported in some parts of the country. India’s high incidence of diabetes complicates the problem, as diabetics are far more prone to catch the infection as well as to suffer recurrences.
The cure for TB is both long and difficult, involving nine months of medication – often with unpleasant side effects – for the drug-sensitive strain, and an even more exacting two-year-long treatment with a much stronger cocktail of drugs, costing Rupee 1 lakh ($2,000) per case, for the drug-resistant variety. (Source: WorldBank.org).
According to the WHO, half of the 10.4 million incident cases of TB in 2016 came from five countries where 20–50% of the urban population live in slums. Socio-cultural barriers to TB treatment in the urban slums have been identified as poverty, overcrowding, stigma, and gender. TB affects an estimated three million women every year and remains among the top five leading causes of death among adult women globally.
The presence of tuberculosis disease during pregnancy, delivery, and post-partum is known to result in unfavorable outcomes for both pregnant women and infants. Globally, pediatric tuberculosis is among the 10 major causes of mortality among children.
Asha’s Tuberculosis Control Program
Asha is treating and monitoring 76 patients in its 91 slums (September 2021) and follows the national DOTS (Directly Observed Therapy) Program based on National TB Elimination Program guidelines and includes:
Increasing awareness and stigma reduction
Asha’s team and CHVs spread awareness of TB causes and symptoms and of extrapulmonary TB, which affects more immunosuppressed people and young children. The team educates people to stay in well-ventilated spaces, stop tobacco consumption, avoid stigmatizing TB patients and adhere to regular treatment.
Screening of TB Patients
The Asha healthcare team and the CHVs identify and screen TB patients based on symptoms through home visits, conducts chest X-Ray and Mantoux tests for suspected patients and screens family members of suspected patients.
The team immediately refers suspected patients to Government TB hospitals and specialized TB centers and ensures that the medicines and the treatment advised by the doctor are strictly complied with by the patient. The team accompany patients with serious complications to Government TB hospitals for admission.
The Asha team provides regular follow-up through home visits and weekly consultations at the Asha clinic, monitoring treatment adherence. Asha also daily provides micronutrient supplements and high protein high energy protein bars (Laddoos) to all TB patients and encourages mask wearing at all times, as well as maintenance of personal hygiene and daily 30-minute exercise. Patients are discouraged from smoking as it interferes with recovery and increases the chance of a relapse.
Asha has achieved a TB Mortality rate across Asha’s slums of 1 per 1,000,000; the National Average is 32 per 1,000,000