16 Nov India: Ashakalp Healthcare Association screens Tribal Groups for TB with the help of Community Health Workers (CHWs)
[vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_separator type=”normal” thickness=”2″ up=”20″ down=”20″][/vc_column][/vc_row][vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_gallery type=”nivo” interval=”3″ images=”2369,2370,2371″ img_size=”full”][vc_column_text]Ashakalp Healthcare Association (formerly known as Asha Kalp) is an organization that engages local youth as Community Health Workers (CHWs) and extensively trains them on various aspects of TB and the treatment to help fight the disease. The CHWs have a fixed number of villages assigned to them where they carry out door-to-door active case finding activities.
The targeted group for this intervention was the Sahariya tribe, which is a particularly vulnerable tribal group with a staggering prevalence of 3,300/100,000 according to a study carried out by the Indian Council of Medical Research. This is an indigenous group that resides in remote locations and has poor health-seeking behavior. Most of them are illiterate, live in a single room home with no ventilation and work as laborers when the employment is locally available and when it is not, they generally migrate to nearby districts to work in agriculture.
The project took place in 6 Treatment Units (TUs) of 2 districts called Gwalior and Shivpuri in the state of Madhya Pradesh in India. This tribal group cannot easily access the TUs because of poor transportation and roads that are susceptible to weather.
With the Stop TB Partnerships’s TB REACH funding waves 4 and 5 funding, CHWs were able to perform oral screening in the assigned villages to identify presumptive cases. They collected sputum samples –1 on the spot and 1 in the morning – and transported them to the government laboratory for testing. When the results were available, CHWs notified the patients and treated them at their doorstep for the entire duration of the treatment.
Additionally, CHWs provided counseling to the patients and their family members during the different phases of the treatment: before initiation, at the completion of the intensive phase (IP) to avert possible loss to follow-up, and just before the last test. They also carried out default retrieval activities to bring the lost to follow-up cases back in the treatment network and sensitized the community on TB.
The intervention in TB REACH funding wave 5 was a scale-up of Ashakalp’s previous work in funding wave 4. Lessons learned from the W4 project served to develop an electronic database management application to track patients through the entire care cascade. This helped identify the lost to follow-up cases. The project was also able to create a Patients’ Club formed by previously treated patients whose task was to sensitize potential lost to follow-up cases to keep them on treatment. Moreover, the CHWs were provided with incentive-based remunerations to appropriately reward their performance.
A target of ~141’500 verbal screens was initially set up, but it was surpassed by 139% with 196’439 people being screened between Q2 2017 and Q2 2018. Out of these, 12’262 people had TB symptoms; 11’212 were tested with smear microscopy and 2’503 were positively diagnosed with active TB disease. All of these new patients were put on treatment and loss to follow-up between identification and treatment initiation in this cohort was successfully averted thanks to the work of the CHWs. This led to a significant increase in case notification of the NTP, which went from 1’551 SS+ patients (during baseline) to 3’164 (intervention period).
Going forward, Ashakalp plans to conduct similar interventions in tribal groups with an increase of 15 TUs in a different state called Maharashtra, where the agreement with the State TB Cell has been signed. The work in Madhya Pradesh has been taken over by the National Institute For Research In Tribal Health (NIRTH) which is fully supported by the State Government.[/vc_column_text][/vc_column][/vc_row]