TB is a complex disease, the impact of which is strongly affected by socio-economic conditions including gender, occupation and living conditions. Our innovations in TB have been developed after extensive research into the barriers faced by different vulnerable groups and gaps in the health system. These range from behaviour change solutions to help persons seek testing and adhere to treatment, to models designed to identify at-risk persons, and engage community organisations and health facilities to better support persons with TB and their caregivers.
Care and Support Groups (2019 onwards)
Care and Support Groups (2019 onwards)
Tuberculosis is a disease with enormous and far-reaching socio-economic consequences for persons with TB and their families. Stigma from communities can lead to a loss of livelihood and profound sense of isolation which can hamper recovery.
We established Care and Support Groups for persons with TB at health facilities to serve as safe spaces for persons with TB and their caregivers to share their experiences and support each other through their treatment journeys. Healthcare providers would also be present to allay their fears and address their concerns. We have established over 330 Care and Support Groups in Karnataka, Telangana, Assam and Bihar. Our approach, which goes a long way in enabling health facilities to be person-friendly and accessible, has been recognized by the Central TB Division at the national level and disseminated to the state TB control programs for adaptation.
Community Structure Engagement (2019 onwards)
Community Structure Engagement (2019 onwards)
Ending TB in India requires, in addition to medical innovations, social interventions which create an enabling environment to help persons with TB recover and resume normal life. As the Government of India called for a community-centred approach to TB elimination, we moved beyond the engagement of only persons affected by TB, to tap the strengths of community structures for greater impact.
We harnessed the potential of community structures in different contexts, ranging from Self-Help Groups, youth associations, faith-based organizations and labour unions, to mobilize their networks and resources to support persons with TB and create a greater awareness of TB in their communities. These community structures went on to identify persons with symptoms and refer them for testing and follow-up to ensure that they completed their treatment. We have capacitated over 3700 community structures in Karnataka, Telangana, Assam and Bihar. The Central TB Division endorsed our model and disseminated it to state TB control programmes in 2021.
Behaviour Change Solutions (2021 onwards)
Behaviour Change Solutions (2021 onwards)
We have developed a series of nine Behaviour Change Solutions for persons with TB, caregivers and frontline health workers based on an extensive behavioural research process with vulnerable communities in the four states of Assam, Bihar, Telangana and Karnataka. The research was carried out among urban vulnerable, migrants, miners and industrial workers, tribal populations and tea garden workers to understand the barriers and enablers to health seeking and treatment adherence at the individual, family, community, and health systems levels. Based on the findings, behaviour change solutions were developed to promote access to healthcare and adherence to treatment. There are nine solutions being piloted in the four states, and some of the state TB control programmes have already adapted solutions such as the TB Jaanch coupon to encourage the uptake of free-of-cost testing services in the public sector.
Differentiated Care Model in TB Care (2019)
Differentiated Care Model in TB Care (2019)
Our fieldwork in rural and urban settings helped us understand that although anyone can get TB,there are certain populations that are more at risk of developing TB due to pre-existing health conditions, occupational hazards or socio-economic conditions. We developed an approach to prioritized care on the basis of a risk and needs assessment. This approach, called the Differentiated Care Model (DCM), identified seven categories of patients most vulnerable to unsuccessful treatment outcomes including persons with drug-resistant TB, persons with HIV-TB, previously-treated persons, persons with TB and diabetes, people living alone, those consuming alcohol, and the elderly. The model would go beyond a one-size-fits-all approach to care, offering each category of at-risk persons a tailored package of care and support services, including counselling, to help them complete treatment.
Specimen Collection and Transportation System (2017)
Specimen Collection and Transportation System (2017)
We designed a Specimen Collection and Transportation system to transport sputum samples from private hospitals to laboratories and testing facilities for free-of-cost testing, with the intention of reducing delays in TB testing and diagnosis, allowing for early initiation on TB treatment. It has been operational through different TB projects since 2017, implemented initially among both public and private health facilities in urban and per-urban settings, and has proven to be flexible and scalable. The system has been transitioned to the Bruhat Bengaluru Mahanagara Palike (BBMP); a Memorandum of Understanding (MoU) was signed in December 2022 between the District TB Office, Bengaluru City, and the Swami Vivekananda Youth Movement (SVYM), a nonprofit organization which will operate the system in Bengaluru.
TB Careline (2014 onwards)
TB Careline (2014 onwards)
The TB Careline is a phone-based patient care and support service providing information on TB, treatment monitoring and counselling to persons with TB and caregivers free of cost. Staffed by a team of counsellors, the Careline intends to improve treatment outcomes through the systematic counselling process of persons with TB on treatment.
In the initial years, a network of private healthcare providers provided newly-diagnosed persons with the Careline number, to which the patient could give a missed call to be registered. The scope of the Careline was later expanded to include persons notified to the government health system as well. The Careline also encompasses the ‘Phone a Friend’ initiative of the Breaking the Barriers project, and has been supported by the state in Koppal district. Its success, and our operational experience, inspired us to launch Sahita Careline, a mental health counselling helpline in 2021.
Mapping vulnerable populations (2021)
Mapping vulnerable populations (2021)
The first step to design a successful intervention that can truly address the barriers of hard-to-reach, at-risk, and underserved populations is to understand the specific barriers and enablers for each vulnerable group. We designed a mapping exercise for our work with various priority populations including urban vulnerable groups, tribal communities, migrants, and mining and industrial workers, in the states of Karnataka, Telangana, Assam, and Bihar. The primary objective of the mapping exercise was to systematically collect and collate socio-demographic details of particular vulnerable populations, to help in the formulation of programme strategy. The mapping exercise in four states helped us hone our approaches to best respond to the overall health needs of diverse groups in a systematic manner.