Tuberculosis

Tuberculosis_FAQs_12_September_2022.docx

Tuberculosis (TB) remains a significant public health challenge in many parts of the world, including India. To combat this formidable adversary, government initiatives often collaborate with non-governmental organizations (NGOs) under the Public-Private Partnership (PPP) model. KNEUS, a dedicated NGO, has been working tirelessly in partnership with the Revised National Tuberculosis Control Program (RNTCP) in the northern Indian state of Uttar Pradesh since 2003. This article delves into the details of KNEUS' impactful journey in the field of TB elimination over the past two decades.

Uttar Pradesh, one of the most populous states in India, has been grappling with the burden of tuberculosis for years. Recognizing the need for innovative and community-centric approaches, the RNTCP initiated partnerships with NGOs to enhance the reach and effectiveness of TB control efforts. KNEUS, with its unwavering commitment to healthcare and community development, became a vital ally in this fight.

KNEUS: The Driving Force

KNEUS, formally known as the Kusht Niyantran Evum Unmoolan Samiti, is an NGO with a long-standing history of service to the underprivileged and marginalized communities in Uttar Pradesh. Established with the vision of holistic development, KNEUS operates across multiple sectors, including health, education, and livelihood empowerment.

Commencement of TB Control Activities

In 2003, KNEUS embarked on a significant journey by joining hands with RNTCP under the PPP model. This partnership marked the beginning of their dedicated efforts to eliminate TB in the state. Over the years, they have expanded their reach and intensified their activities to address the multifaceted challenges posed by TB.

Key Achievements

KNEUS' Impact on TB Control

KNEUS has played a pivotal role in improving TB control measures in Uttar Pradesh. Their achievements include:

Increased Case Detection: Through community-based initiatives, KNEUS has actively contributed to increased case detection rates, ensuring that TB patients receive timely treatment.
Patient Support and Counseling: The organization provides essential psychosocial support and counseling to TB patients and their families, reducing the stigma associated with the disease.
Enhanced Treatment Adherence: KNEUS' interventions have resulted in higher treatment adherence rates among TB patients, leading to better treatment outcomes.
Advocacy and Awareness: They have been instrumental in creating awareness about TB in communities, thus encouraging early diagnosis and treatment.
Capacity Building: KNEUS has played a crucial role in building the capacity of healthcare workers and community volunteers, strengthening the overall TB control infrastructure.

Community Engagement

One of the cornerstones of KNEUS' success has been its active involvement with communities. Through various programs and initiatives, they have fostered community engagement and ownership of TB control efforts.

TB Awareness Campaigns: KNEUS conducts extensive awareness campaigns in communities, schools, and workplaces to educate people about TB symptoms, prevention, and treatment.
Community Health Workers: The organization has trained and deployed community health workers who play a pivotal role in identifying potential TB cases and providing information and support.
Patient Support Groups: KNEUS has facilitated the formation of patient support groups, where TB survivors share their experiences, offer emotional support, and motivate others to adhere to treatment.

Challenges and Solutions

KNEUS' journey in TB control has not been without its share of challenges. Some of the prominent challenges they've faced include:

Stigma: TB-related stigma remains a significant barrier to early diagnosis and treatment. KNEUS has addressed this issue through sensitization programs and community engagement.
Access to Healthcare: In remote and underserved areas, access to healthcare facilities remains a challenge. KNEUS has established mobile clinics and outreach programs to bridge this gap.
Drug Resistance: The emergence of drug-resistant TB strains is a growing concern. KNEUS has been actively involved in efforts to prevent and manage drug-resistant TB cases.
Funding: Sustainable funding for TB control activities is a perpetual challenge. KNEUS has diversified its funding sources and engaged in advocacy for increased investment in TB control.

Future Directions

As KNEUS continues its remarkable journey in TB control, the organization envisions several key areas for future growth and impact:

Innovative Technologies: Embracing emerging technologies such as telemedicine and digital health records to improve diagnosis, treatment, and monitoring.
Scaling Up: Expanding their reach to cover more districts and communities in Uttar Pradesh, especially in remote and underserved regions.
Research and Advocacy: Engaging in research to better understand local TB dynamics and advocating for evidence-based policy changes.
Sustainability: Strengthening partnerships with government agencies, international organizations, and corporate entities to ensure the sustainability of their TB control efforts.

KNEUS' exceptional journey in the field of tuberculosis elimination through the RNTCP PPP/NGO partnership in Uttar Pradesh since 2003 stands as a shining example of the impact that dedicated organizations can have on public health. Their unwavering commitment to communities, innovative approaches, and tireless efforts have not only improved TB control in the region but also transformed the lives of countless individuals. As they continue to evolve and adapt to new challenges, KNEUS remains a beacon of hope in the fight against TB in India.

KNEUS' Remarkable Journey in Tuberculosis Elimination through RNTCP PPP/NGO Partnership in Uttar Pradesh Since 2003

FREQUENTLY ASKED QUESTIONS ABOUT TUBERCULOSIS

What is tuberculosis?

Tuberculosis (TB) is an infectious disease caused by the bacteria Mycobacterium tuberculosis. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, the spine, etc.,

2.How do I know if I have TB?

Symptoms of TB are usually specific to the site affected by the bacteria. Although there are some symptoms common to all types of TB, an indicative list of symptoms is given hereunder (if you experience any symptoms associated with TB, you must visit a health centre and get yourself tested immediately):

Symptoms of Pulmonary TB or lung TB:

Persistent cough for two weeks or more
Chest pain
Shortness of breath
Blood in sputum

Symptoms of Extra Pulmonary TB depend on the site/organ affected:

Brain TB- meningitis
Lymph node TB - enlarged lymph nodes
Bone TB - the destruction of bones and joints
Abdominal TB –Intestinal obstruction

Common symptoms

Weight loss
Fatigue
Evening rise of temperature (Fever)
Night sweats

What do I do if I notice symptoms of TB?

If you, or someone you know, is experiencing symptoms of TB, please visit your nearest health centre for a checkup. TB treatment is available free of cost at all government and identified private and NGO health facilities called treatment centres.

It will be useful to download the TB Aarogya Saathi app on your phone for basic clarifications and resources. You could also call the toll-free number 1800-11-6666 for further counseling and support.

How is TB diagnosed?

TB is diagnosed by demonstrating TB bacteria in a clinical specimen taken from the patient. While other investigations may strongly suggest tuberculosis as the diagnosis, they cannot confirm it.

Pulmonary TB is diagnosed through sputum smear microscopy and/or Chest X-Ray.

In Extra-pulmonary TB it is usually difficult to demonstrate TB bacteria, hence the diagnosis is made based on clinical suspicion and special tests depending on the organ affected. For instance, TB of the lymph nodes is diagnosed by a special test called FNAC (Fine Needle Aspiration Cytology).

In addition, NAAT (nucleic acid amplification test) is increasingly being used for diagnosing TB. They are highly accurate and rapid molecular tests. In addition to detecting TB, it also detects drug resistance to one of the potent anti-TB drugs, Rifampicin.

How do I locate a TB diagnostic centre in my district?

You can download the TB Aarogya Saathi app on your phone and go to “Health Facilities” to find both government and private sector TB health centres in your districts. You can also find the names and contact numbers of point persons at those health facilities. You could also call the toll-free number 1800- 11- 6666 for further help and information.

Is TB curable?

TB is curable if the prescribed drugs are taken regularly for the complete duration.

Is TB always infectious?

Microbiologically confirmed pulmonary TB patients (people with lung TB) are infectious. However, these patients don’t remain infectious, if at least 2 weeks of Anti TB medicines are taken. It is important to complete the entire duration of medication. In comparison, if it's a case of TB affecting other organs (other than the lung), then they are not infectious.

Wearing a mask potentially cuts transmission of the disease/infection, therefore person who has cough for any duration (even if not yet tested) is encouraged to wear a mask.

How does TB spread? Am I likely to spread the infection if I share food or shake hands with someone too?

TB spreads when a person with active lung TB talks, sings, coughs, or sneezes releasing TB bacteria in the air, in the vicinity of susceptible individual. However, TB does not spread through handshakes, using public toilets, sharing food and utensils, and casual contact. TB patients can continue living their normal lives after treatment completion. They should cover their mouth and nose while coughing and sneezing as a practice.

How long does it take to recover from TB?

The duration and nature of TB treatment depend upon the resistance to drugs available for treatment. For drug-sensitive TB patients, the treatment is generally 6-9 months.

Some patients might have resistance to one or few of the drugs used to treat TB. In that case, the treatment might be longer. After the diagnosis of TB, patients are offered cascade testing to check if they are resistant to any line of TB drugs. Patients may be diagnosed with DR-TB (Drug-Resistant, MDR-TB (Multi-Drug Resistant), pre-XDR (pre Extensively drug-resistant TB), or XDR-TB (Extensively drug-resistant TB) depending upon the TB drugs they are resistant to.

I have TB. What kind of diet should I follow?

TB patients should consume a nutritionally rich and balanced diet that has all nutrients in the required proportions. For example, the diet may include cereals (maize, rice, sorghum, millets, etc.); pulses (peas, beans, lentils, etc.); oil; sugar, egg, fish etc.

What kind of social support am I entitled to from the government especially to address nutrition needs?

Under the “Nikshay Poshan Yojana”, the Government of India provides 500 rupees each month to TB patients for the entire duration of their treatment as nutrition support.

Who can be affected by TB?

Anyone can be affected by TB but there are few conditions that increase the likelihood of developing active TB disease. These include:

Close prolonged contact with a person with Pulmonary TB
Being in an overcrowded environment
Smoking
HIV infection
Malnutrition
Diabetes patients
Patients on immunosuppressive drugs (anti-cancer, corticosteroids etc.)
Certain lung diseases like silicosis which causes scarring of the lungs

Should a TB patient be dealt with differently within the household and/or community?

TB patients, must be supported through their recovery and encouraged to complete their treatment and to take a nutritious diet. There is no need to ostracize TB patients or spread unverifiable and incorrect information about the disease. With complete and correct treatment, TB is completely treatable.

What do I do if my family member has TB?

As a caregiver, ensure that TB patients complete their prescribed treatment and take a nutritious diet during and post their treatment. If they have lung TB and you were in close prolonged contact with them, contact your nearest health centre to take professional advice. You can find the centres through the “Health Facilities” section in the TB Aarogya Saathi app.

What are the side effects of TB drugs?

Not everyone suffers from the side effects of TB drugs. But sometimes TB patients can have adverse reactions to drugs, and these may include nausea, vomiting, gastritis, itching etc. In this case, the patient should contact their treatment provider and not stop the treatment. Incomplete treatment can lead to drug resistance.

How are TB and COVID-19 related? Can one disease act as a risk factor for the other?

TB and COVID-19 both primarily affect the lungs although TB is caused by bacteria and COVID-19 by a virus. Many symptoms of COVID-19 and TB are similar as well. Therefore, if you have symptoms such as cough, fever, and difficulties in breathing, get yourself tested for both COVID-19 and tuberculosis.

How are TB and HIV related?

HIV is the strongest risk factor for tuberculosis among adults as it adversely affects the immune system. An HIV-positive person is 20-40 times more likely to develop TB disease once infected as compared to an HIV-negative person.

Can TB be cured in HIV co-infected patients?

TB is curable in patients who suffer from HIV using the same medicines which are used to treat HIV-negative TB patients. However, HIV/TB co-infected patients require additional medications such as Antiretroviral Therapy (ART) and Co-trimoxazole preventive therapy (CPT) to prevent other opportunistic infections.

How is it assessed whether the patient is responding to TB treatment?

The response to treatment in the case of patients with pulmonary TB is assessed by follow-up sputum examinations/culture done at regular intervals over the course of treatment. The sputum examination is also done at the end of the treatment to declare the patient cured. The response in extra-pulmonary TB patients is assessed through clinical improvement and follow-up investigations such as X-rays, CT scans, etc. depending on the site affected.

Since the treatment duration is long, what happens if a patient shifts their place of residence?

There is a provision of ‘Transferring Out’ to ensure continuity of treatment and care services if a patient shifts their residence to anywhere in the country. The patient simply needs to inform the programme officials in the district where s/he was originally notified about her/his location change. The details are automatically updated via the Ni-kshay system. All medications and social support benefits can then be availed by the patient in the new location of residence. The remaining treatment is then continued at the treatment centre or unit nearest to the new residence of the patient.

21 I have a regular doctor who is my family physician. Can I go to him/her for guidance on TB?

You can consult any certified MBBS doctor for medical advice. They are best placed to diagnose and provide treatment. It is important to remember that TB is diagnosed through appropriate sputum examinations and/or molecular diagnostic testing.

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