Impact of Advocacy, Communication, Social Mobilization and Active Case Finding on TB Notification in Jharkhand, India

Ajay Madhugiri Venkatachalaiah Kumar,Banuru Muralidhara Prasad,Gayadhar Mallick,Hemant Deepak Shewade,Kiran Kumar Reddy,Moumita Biswas,Om Prakash Bera,Prabhat Pandey,Raghuram Rao,Rakesh Dayal,Sarabjit Singh Chadha,Sashikanta Nayak,Srinath Satyanarayana,Sripriya Pandurangan,Subrat Mohanty,Sukhwinder Singh,Vaibhav Haribhau Ghule,Vivek Gupta

doi:10.2991/jegh.k.190812.002

Ajay Madhugiri Venkatachalaiah Kumar, Banuru Muralidhara Prasad + Show 16 more

Open Access

https://doi.org/10.2991/jegh.k.190812.002

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Abstract

Community-level benefits of screening for active tuberculosis (TB) disease remain uncertain. Project Axshya (meaning free of TB) conducted advocacy, communication, social mobilization, and active case finding among vulnerable/marginalized populations of India. Among 15 districts of Jharkhand state, the project was initiated in 36 subdistrict level administrative units — tuberculosis units (TUs) in a staggered manner between April 2013 and September 2014, and continued till the end of 2015. Seven TUs did not implement the project. We assessed the relative change in the quarterly TB case finding indicators (n = 4) after inclusion of a TU within the project. By fitting four multilevel models (mixed-effects maximum likelihood regression using random intercept), we adjusted for secular (over previous five quarters) and seasonal trends, baseline differences within Axshya and non-Axshya TUs, and population size and clustering within districts and within TUs. After inclusion of a TU within the project, we found a significant increase [95% confidence interval (CI)] in TU-level presumptive TB sputum examination rate, new sputum-positive TB Case Notification Rate (CNR), sputum-positive TB CNR, and all forms TB CNR by 12 (5.5, 18.5), 1.1 (0.5, 1.7), 1.3 (0.6, 2.0), and 1.2 (0.1, 2.2) per 100,000 population per quarter, respectively. Overall, the project resulted in an increase (95% CI) in sputum examination and detection of new sputum-positive TB, sputum-positive TB and all forms of TB patients by 22,410 (10,203, 34,077), 2066 (923, 3210), 2380 (1162, 3616), and 2122 (203, 4059), respectively. This provides evidence for implementing project Axshya over and above the existing passive case finding.

Highlights

There were an estimated 10 million new patients with tuberculosis (TB) in 2017
Multilevel modelling indicated that there was a significant change in the presumptive TB sputum examination rate, new sputumpositive TB Case Notification Rate (CNR), sputum-positive TB CNR, and all forms TB CNR by 12, 1.1, 1.3, and 1.2 per 100,000 population per quarter, respectively, before and after implementing Axshya activities (β2 coefficient)
In a setting with an overall decreasing trend of case finding indicators, project Axshya resulted in an increase in presumptive TB sputum examination rate and TB CNRs in Axshya tuberculosis unit (TU) when compared with Passive Case Finding (PCF) after adjusting for the secular and seasonal trends and baseline differences in indicators between Axshya and non-Axshya TUs

Summary

Introduction

There were an estimated 10 million new patients with tuberculosis (TB) in 2017. Despite significant gains made by India’s Revised National TB Control Programme (RNTCP) in terms of lives saved, India still accounts for one-third of ‘missing’ 4.3 million patients with TB globally [3]. Even in high-burden countries, certain marginalized or vulnerable populations are more prone for the disease and screening these populations has been recommended to detect all TB patients early and to ensure their treatment completion [5]. According to the 90–(90)–90 targets set by the ‘global plan to end TB (2016–2020),’ the second 90 deals with reaching 90% of TB among vulnerable/ marginalized populations [6]

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