▪ The main work of the project is to get local people and Outreach workers to identify TB and have    suspected cases referred to one of our microscopy centres. Here they can be tested for both TB and HIV.    If they are diagnosed with TB, we are able to put them onto the correct DOTS medication. Furthermore    our centres are able to provide medical and counselling support for those who are also HIV positive .

▪ The project also focuses on spreading awareness about TB and HIV within the community. This includes    coordinating workshops for community volunteers, to enable them to recognise TB symptoms and be able    to refer any suspects directly to us.
Read about Khasim who was given a second chance by the KRISCHIP project in “Fighting TB: True Stories”

Background: Three partners of APCATH have now set up The Chittoor Coalition Against TB & HIV in response to rising levels of TB-HIV specifically within the district of Chittoor, Andhra Pradesh. TB Alert India, with funding by Zurich, works with the Rural Institute for Social Education (RISE) along with the two other local NGO’s of Stree Sakthi Sanghatana (SSS) and CRLR.

This project is covering 5 mandals and one municipality of Chittoor District with a total population of 360,000 people.

Activities: Started in November 2007, The project covers four microscopy centres and the main aim of the project is to promote the use of the centres by the community by raising awareness about TB and the demand for free treatment. So the project has already established a strong working relationship with the health department staff working at the centres.

An important aspect of this project is the peer educators and cluster co-ordinators who are trained to recognise the symptoms of the disease and how to raise interest and knowledge about the disease within the community.

Awareness has also been raised by the use of “cultural Teams” who go to villages and carry out a programme to teach the community about TB and its linkages to HIV. This will often include a drama about the disease which is a very effective way of gaining a large number of peoples attention. The play is then followed by a question and answer session where our field workers clarified any doubts or misconceptions that exist about TB-HIV. These cultural programs are a very effective way of spreading awareness to a large number of people.

Background: Recognising our experience in working against Tuberculosis, the Andhra Pradesh State AIDS Control Society (APSACS) asked us in September 2006 to implement a HIV-TB intervention programme in the districts of Anantapur, Chitotoor, Kurnool, Hyderabad and Srikakulum.

Andhra Pradesh has one of the highest rates of HIV/AIDS in India. TB too is a serious health problem as it is the most common opportunistic disease to affect and kill those with HIV. Therefore a co-ordinated approach using both National programs is essential in tackling both infections.

Activities: TBAI in partnership with its lead partners Gandhi Memorial Leprosy Foundation(GMLF) and Rural Institute for Social Education (RISE) has been implementing this project since November 2006.

The main activity involves the running of 10 Integrated Counselling and Testing Centres (ICTC’s) in each district, these are centres that can diagnose and deal with both TB and HIV.

The ICTC’s are located in deprived urban areas where there are large populations that have little or no access to health care facilities and where awareness of disease is low. The ICTC’s are able to test for HIV and TB, allowing for HIV-TB suspects to be picked up immediately. They can then receive free treatment for TB by being put on DOTS and receive counselling regarding HIV/AIDS. If necessary the centres can also arrange for patients to be put on Anti-retroviral Therapy (ART’s). This means the centre can provide a holistic HIV programme for the area.

We have also trained 100 Out Reach Workers, 2 per ICTC, to work within the local community and refer TB and HIV suspects to be tested. These ORW’s provide an essential interaction within the community allowing us to spread awareness about the disease, combat the stigma attached to HIV by sensitising local stakeholders and pick up cases of HIV- TB that may otherwise have gone unnoticed.

Background: Since the start of TB Alert India in 2003 we have been working with and building up a network of local NGO’s who are working to improve the status of health within Andhra Pradesh, whether it be connected to TB or other issues. Many of these NGO’s lack the experience and recourses to implement large projects. However they also have the best understanding and knowledge of the local situation so are in a strong position having already built up a rapport of trust within the community.

Therefore TB Alert India decided to establish the APCHIP consortium which is geared at getting 36 NGO’s within the state to implement health initiatives together and support each others work. By a co-ordinated effort we can therefore really combat the major health issues that affect the 6.1 million people in the six districts of Andhra Pradesh State of Anantapur, Chittoor, Kurnool, Cuddapah, Nellore and Prakasham District

Activities: Having received substantial funding from the UK Department for International Development (DFID) we can now initiate a five year project to provide support to these 36 NGO’s, enabling us to implement large scale health projects. This will include providing:

▪  Technical support to participating NGO’s: Such as the necessary training to carry out large scale health projects. Being able to analysis and streamline their work so as to be as effective as possible. As well as provide a body of NGO’s that will be able lobby the state government to provide the free health care that everyone has a right too.

▪ Supporting communities, community groups and interested parties: Such as running school education programs, running community support groups and sensitising community volunteers that wish to take part in the project. We shall further raise awareness within communities using an IEC Mobile Film van to show educational films and street plays to spread awareness. This will further contribute to the sensitisation for religious leaders, community leaders, journalists, media workers to raise awareness of issues relating to local endemic diseases.

▪ Support to Government and private health Service providers: This will mean developing a relationship with Health Authorities to enable our work to complement the government’s strategy for fighting disease. This includes organising experience sharing workshops for Health workers and organising public health Camps. We shall also be able to assist in the implementation of effective patient monitoring mechanisms so to make sure patients complete all medication. This will strengthen networking and partnership between Government, NGO’s, Private health providers and the community.

Carrying the experience of Global Fund Round 7, NGO TB consortium (TB Alert India, World Vision, LEPRA Society, Project Concern International (PCI), CARE, ADRA, GLRA, and PATH) submitted the Concept Notes for Global Fund (Round 8). In early May 2008, Concept Notes was provisionally approved by Global Fund Country Coordinating Mechanism (CCM).

The project will be led by World Vision India and implemented by six member – organizations of the NGO TB consortium(TB Alert India, World Vision, LEPRA Society, , CARE, ADRA, GLRA), that have community based programme experience. The project is estimated to cost US$ 14.4 million (INR 57,78,83,320) over 5 years. Further meetings/discussions will be taken forward in due course of time for the final proposal submission& approval by end of July 2008.Simultaneously depending on operational presence each consortium NGO, state wise & District wise coverage areas will be finalised.

Goal: To contribute to the efforts of RNTCP in decreasing mortality and morbidity due to TB and its complications.

1) To increase case detection and treatment success for TB,
2) To improve access of TB patients to diagnosis and treatment and
3) To increase knowledge and change attitudes towards TB and patients in 48 districts and 7 cities across     Bihar, WB, MP and Orissa and AP.

Coverage:
48 target districts and 7 cities across Indian States of Orissa, West Bengal (WB), Madhya Pradesh (MP), Bihar and Andhra Pradesh (AP) covering a population of 141.5 million including tribal groups and urban poor

The NGO TB consortium seeks to achieve the objectives through expanding the participation of civil society and community structures and catalyzing public and private health systems.End of project targets are case detection rate (CDR) of at least 70% and treatment success rate (TSR) of at least 85% in the covered districts. Key thematic areas are ACSM, Community Systems Strengthening, PPM and Health Systems Strengthening including workplace interventions.  Activities are targeted towards improving community awareness and attitudes related to TB, enrolling NGOs, CBOs, private providers and institutions, building capacity of CBO as well as that of peripheral programme staff in interpersonal skills and, in AP and WB states, specific support on MDR TB and TB HIV coordination.

Activities: With funding from New Jersey Overseas Aid we have been able to implement new x-ray facilities in all four hospitals and so provide free X-rays for people who would not be otherwise able to afford it. We have also helped run TB awareness programmes in the areas around the hospitals including putting on educational dramas and holding sensitisation workshops for local stakeholders. Furthermore we have also conduct training programme on TB for Doctors, Technicians and Paramedical staff within the Hospitals in order that they are able to identify any cases of TB that may go unnoticed.

Hyderabad Urban DOTS – Mahavir Hospital

Since 1995 TB Alert India has been supporting the implementation of the Hyderabad Urban DOTS project. The project involved the implementation of the first ever Public Private mix (PPM) initiative in 2002 at Mahavir Hospital in central Hyderabad, Andhra Pradesh. This meant that
government health care facilities and private heath providers co-operated to fight TB. Using Private practitioners to refer patients to the hospital and then training them to be DOTS providers within their community. Since then the project has been highly successful with Mahavir becoming an internationally recognised example of how PPM can work. The Hospital currently deals with over 90 TB cases a month with its TB Treatment clinic. It is also located close to many of the slum areas within Hyderabad city so is able to focus on vulnerable populations.

The TB clinic at the Hospital is now designated as Tuberculosis Unit (TB Unit) supported by the district TB office. However we are looking to propose a new intuitive within Mahavir and introduce an ICTC ( Integrated Counselling and Testing Centre) which will enable the clinic to also carry out testing and provide counselling to those who are affected by HIV-TB.  

Delhi DOTS
Since 2002 TB Alert India, with the funding from Chest, Heart and Stroke Scotland (CHSS), ran the Delhi Dots Initiative in five areas of Delhi, covering an estimated population of over 0.45 million people. TB Alert India, in partnership with the Voluntary health Association of Delhi (VHAD), established DOTS centres in the five slum areas. These centres were able to identify and cure TB cases in order to reduce the transmission of the disease. After the closure of a major implementing programme in VHAD, TB Alert took over the complete implementation of the project in 2006 with the aim of phasing it out by March 2008.

 TB Alert has trained local people within the community to be DOTS providers, as a result enabling the community to be self reliant in recognising and curing the disease. By November 2007 we have trained over 100 community DOTS providers who are treating 364 patients.  We have now linked our DOTS providers and patients to the State TB Office so that they can now run the project sustainably.

Seeing the success of the Delhi Dots Project, the State and District TB Office requested TB Alert India to implement the same community approach in another area of North East Delhi called Burari. (See Divine TB Project)

Nav-Jivan Hospital – JHARKHAND

Since April 2001 TB Alert India supported the Navjivan Hospital in Jharkhand state. The Hospital was serving a population of more then one Lakh (10,000) in a very difficult and underserved region. The project developed a model TB programme incorporating diagnosis, treatment and follow-up services.  The only other healthcare facilities in the area where extremely limited and consist mainly of private practitioners who are expensive and varying in skills and expertise. Due to excellent outreach awareness programmes, the number of patients coming to the hospital with suspected TB more than trebled since 2001. 

TB Alert funded construction of a building exclusively for TB Services on the hospital campus. This now serves as the district TB treatment unit managing 5 microscopy centre areas.  Till December 2006 the project facilitated in treating over 700 TB patients.

With the experiences of the project to fill the gap particularly for low literate/tribal population who are located in difficult to reach areas of Satbrwa of Palamu District of Jharkhand State. It is proposed to have a Mobile IEC Van. As IEC Van requires lesser personnel, more effective with audio and visual component and has more impact when coupled with health education and IEC materials.

The aim of the project is to create primarily TB awareness and also followed by the other local endemic diseases in the community by organising IEC Film shows in difficult to reach areas of where majority of the population are illiterates up to 60% and are subsistence farmers most of whom do not own any land of their own and therefore are daily wage earners from rich landlords. The shows will be more beneficial to the illiterate audiences.

Mobile IEC Van film shows will be shown in villages in the evenings. IEC films shows are one of the effective medium in spreading the awareness about the diseases. The films will show people interacting with the health system and bring in messages which encourage local people to demand their rights. As the disease information shown is blended with the local film songs, these shows have been of pioneer in gathering people for film shows/ identification and referring the suspects.

To raise TB awareness among children IEC van films shows will also be screened in the schools which are located in remote / tribal places like Primitive Tribal/ Scheduled Caste (lower caste) Scheduled Tribe schools. Simultaneously Class teacher will be sensitised in symptoms of local endemic diseases, healthcare facilities available and healthcare rights to disseminate the information to students during morning assembly.

Where ever there is an opportunity IEC van will be utilised to organise a small exhibition in the ‘Haat’ – a local village market. The proposed start of the project will be from Mid of 2008.

Network for Tribal Health Rights & Advancement (NETHRA)

TB Alert India has roped in 10 other Grass Root Tribal based NGO’s to create NETHRA. We are currently carrying out a situation analysis survey of 4 Tribal dominated districts in Andhra Pradesh and 4 districts of Tamilnadu focusing on the existing tribal populations who live in relatively inaccessible areas. These communities have very little access to health care, and rely on traditional medical practices of their village to stay healthy. Also concerning is their ignorance of more serious infectious diseases like TB, Malaria and AIDS, as well as the dangerous methods of child delivery that they adopt.

The NETHRA project plans to use health workers to enter these communities and provide basic health care, plus diagnose serious illnesses that require medical treatment as well as raise awareness to the dangers of these diseases. It is clear that any health initiative in these areas will require a holistic approach and cover a wide range of issues as it would be useless to go in focusing on only one. By using local NGO groups that have gained the trust of the tribal communities and have knowledge about the local situation we will be able to implement health care programme to stop the spread of disease.

Establishment of Integrated Counselling and Testing Centre (ICTC) at Mahavir Hospital

Since 1995 TB Alert India has been supporting the implementation of the Hyderabad Urban DOTS project. The project involved the implementation of the first ever Public Private mix (PPM) initiative in 2002 at Mahavir Hospital in central Hyderabad, Andhra Pradesh. This meant that

government health care facilities and private heath providers co-operated to fight TB. Since then the project has been highly successful with Mahavir becoming an internationally recognised example of how PPM can work. The Hospital currently deals with over 90 TB cases a month with its TB Treatment clinic. It s also located close to many of the slum areas within Hyderabad city so is able to focus on vulnerable populations.

 However it is now recognised that a HIV-TB initiative is also required to provide a holistic approach to fighting TB due to the prevalence of HIV among TB patients. The Andhra Pradesh State AIDS Society has therefore asked TB Alert India to implement a new Integrated Counselling and Testing Centre (ICTC) at Mahavir Hospital. This will provide a facility where both TB and HIV can be tested for and where people can receive free counselling on how to both prevent catching HIV-TB and how patients can live with the disease.