Tuberculosis

We develop and implement effective and comprehensive solutions for tuberculosis (TB) prevention, care and control using a patient-centred and family-focused approach.

India bears a quarter of the global TB burden, with an estimated of 2.79 million cases in 2016,  A large proportion of these cases have not been reported to Nikshay, the national registry for monitoring TB patients. These ‘missing’ cases may be undiagnosed or receiving non-standardized treatment. Patients receiving non-standardized treatment or individuals who discontinue treatment run the risk of developing Drug Resistant TB (DRTB). This is a major obstacle to effective TB care and prevention, as DRTB is harder and more expensive to treat, and takes longer to cure.

Our specific focus is finding “missing” TB patients and working towards TB elimination by integrating these patients into a continuum of care which starts with health seeking behaviour, treatment and diagnosis, and goes all the way to care and support services, and followup . Our work empowers vulnerable communities to access quality TB services, enhance their health seeking behaviour, enhance the involvement of private healthcare providers in TB control to, bridge the private-public health sector gap in TB treatment. and influence policy. This is done through intensive engagement with communities, community structures and institutions, and the government, in alignment with the Government’s National Strategic Plan for TB Elimination in India (2017-2025).

 


Current Projects

THALI

Improving TB control in urban India

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JEET: Private sector engagement towards TB control

Set up effective and sustainable structures to strengthen existing systems and extend quality TB care

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Concluded Projects

  • Axshya: Providing Supportive Supervision for Counsellors working in DRTB sites

    Project Axshya (meaning ‘free of TB’) was launched in April 2010 as
    the civil society component of a five year project funded by a Round 9
    grant from the Global Fund to Fight AIDS, TB and Malaria (The Global
    Fund).The government is focusing on scaling up access to MDR-TB
    diagnosis and treatment to over 750 million people by 2015. Axshya
    aims to support the Government of India’s Revised National
    Tuberculosis Control Programme to expand its reach, visibility and
    effectiveness. It engaged community based providers to improve TB
    services, especially for women and children, and marginalised,
    vulnerable and TB- HIV co-infected populations. Axshya is
    coordinated by two civil society representative organisations-
    International Union against Tuberculosis and Lung Disease and South
    EAST Asia Office and World Vision India. KHPT implemented it from
    2010 to 2015 in Karnataka.

  • SHOPS – TB
    • SHOPS-TB:Strengthening private providers’ capacities in TB prevention and care

      Globally, one in four persons with tuberculosis (TB) lives in India where an estimated 2.1 million develop TB each year and 240,000 die of the disease. An estimated one million people in India with active TB are ‘missing’, and believed to be managed by private health providers. Such patients are not notified to health authorities and are presumed to be poorly managed.

    • Context

      The private sector is the first point of contact for health services for the majority of people in India accounting for 60 to 80 per cent of outpatient health care in India. However, only two per cent of all patients referred for TB diagnosis and testing are from the private sector. This relatively low number of referrals suggests that a significant number of patients are receiving TB treatment in the private sector. Many patients with TB, especially those on private treatment, but including beneficiaries of DOTS, the strategy implemented by India’s Revised National Tuberculosis Control Programme (RNTCP), receive inadequate or inappropriate treatment support. This result in treatment non-compliance, sub-optimal treatment outcomes, spread of infection and increased risk of drug resistance.

    • Implementation

      The intervention demonstrated an interface mechanism to improve access to quality TB services by engaging and building the capacity of private healthcare providers. It focused on engaging the urban slum community to raise awareness, building capacities of the private providers and bridging gaps between the private and public healthcare sectors. A successful adaptation of the public private provider interface (PPIA) model, developed by Bill and Melinda Gates Foundation in 2013, it was funded by USAID.

       

      KHPT implemented the project from 2014 – 2015 in 42 towns across 12 districts in Karnataka in collaboration with Abt Associates.

    • Impact

      The programme resulted in:

      • 50 per cent reduction in the delay in initiating TB treatment of patients diagnosed under the public sector programme in the intervention areas
      • a clear increase in the numbers of suspect TB patients accessing the Designated Microscopy Centres (DMC) for diagnosis of the TB
      • 28 per cent increase in the total TB patients diagnosed in the year from the implementation districts
      • the use of innovative methods including a telephone ‘care-line’ and patient support groups, which ensured that treatment adherence among patients taking treatment from the private sector was at par with the national programmes
      • an improved understanding of influencers of urban slum communities towards better health seeking and treatment behaviour

       

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  • Market-based Partnerships for Health (MBPH) Project: An initiative to enhance participation of private healthcare providers in the Revised National Tuberculosis Control Program

    The project used a social franchising model to create and expanded the network of private providers on a large scale to adopt DOTS referral, diagnosis and treatment policies. A high intensity community outreach plan covered 50 per cent of the targeted population in urban slums in 13 districts in Karnataka. The communities were mobilised to substantially reduce gaps in knowledge, improve their ability to access TB services and successfully adhere to treatment as mandated by the protocols. A systematic, collaborative sustainability plan was designed with the country’s Revised National Tuberculosis Control Programme (RNTCP) for eventual transition to the government. KHPT implemented the project, funded by USAID through Abt Associates, Delhi, from 2011 to 2012.